Anesthesia for the Patient with a Single Ventricle

Predicting the pressure of the total cavopulmonary connection: clinical testing of a mathematical equation

“…Moreover, the performance of the Fontan system itself depends on several variables such as a good systolic and diastolic function, the sinus rhythm, low pulmonary pressure and vascular resistances, and good respiratory function. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] It is also debated if the Fontan outcome is influenced by pre-Fontan haemodynamic data. 6,[13][14][15][16][17][18][19][20] In fact, even if some studies underlined that the pre-Fontan haemodynamic data do not affect short-term post-Fontan outcome, [13][14][15] the majority of the authors agree on the importance of performing a pre-Fontan haemodynamic assessment to obtain the valuable data as the need for fenestration and anticipate the need for peri-operative systemic or pulmonary 18 Bridges et al underlined that the pulmonary artery size could not be considered alone as the major determinant of Fontan outcome.…”

“…Finally, among the variables that affect the Fontan outcome, several authors identified the Fontan system pressure as one of the major determinants of the proper functioning of the total cavopulmonary connection. 1,5 In particular, several papers underlined that higher Fontan system pressure is associated with an increased risk of failure or death. [7][8][9][10] Salvin et al report about the relation between the Fontan pressure system and the duration of effusions.…”

“…12 With all these premises, the use of a dedicated formula to predict the pressure in the Fontan system starting from pre-Fontan catheterisation data could be an additional information in this group of patients. 4,5 Although this formula is not very widespread, in our work, we aimed at retrospectively testing this equation, as in literature there are no studies focused on the formula validation.…”

“…Therefore, different centres can prefer one parameter instead of another or can use different cutoffs. [1][2][3][4][5][6][7][8][9][10][11] We correlated, using ROC curves, the needs for fenestration with the predicted Fontan pressure. Statistical Analysis: Data were expressed as mean values and standard deviation or as median values and interquartile range, where appropriate.…”

“…In fact, pre-Fontan catheterisation could permit to select high-risk patients for surgery and to perform interventional procedures that could improve post-operative outcome of these patients. [1][2][3][4][5][6] Among the factors determining the outcome of Fontan patients, the pressure of the total cavopulmonary anastomosis plays an important role. [1][2][3][4][5][6] Some authors advocate the use of a dedicated empirical formula to predict the pressure in the total cavopulmonary anastomosis (P fontan ) starting from pre-Fontan catheterisation data 5,6 :…”