Sizing Up Fontan Failure: Association with Increasing Weight in Adulthood

Byrne, Ryan; Weingarten, Angela; Clark, Daniel E.; Healan, Steven; Richardson, Tadarro L.; Huang, Shi; Menachem, Jonathan N.; Frischhertz, Benjamin P.

doi:10.1007/s00246-021-02628-8

Cited by 9 publications

(10 citation statements)

References 21 publications

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“…The studies in this review identified several factors positively associated with BMI [21,27,28,39,[50][51][52][53][54][55][56][57][58][59][60]. As is supported in the broader population, increasing age in the adolescent and young adult populations was generally strongly associated with increasing BMI, and age was thus often adjusted for in the analyses.…”

Section: Bmi-associated Patient Factorsmentioning

confidence: 79%

“…These findings are potentially significant given the evidence of VO 2 as a predictor of mortality and heart transplant [61]. There is also evidence of higher systolic blood pressure and ventricular hypertrophy in young overweight Fontan patients [28,56]. The effects of obesity mediated by hypertension on the functional single ventricle require further evaluation.…”

Section: Impact Of Overweight On Physiological Parametersmentioning

confidence: 94%

“…As is supported in the broader population, increasing age in the adolescent and young adult populations was generally strongly associated with increasing BMI, and age was thus often adjusted for in the analyses. BMI z-scores (BMIz) were also found to increase with age for Fontan patients into adolescence and adulthood, reflecting the trend towards correction of poor growth over time [56][57][58]60]. Other factors associated with increased BMI included higher oxygen saturations [61], younger age at Fontan procedure [57], and left ventricular dominance [60].…”

Section: Bmi-associated Patient Factorsmentioning

confidence: 99%

“…Conversely, Byrne et al [56], in a study of 104 adult patients (mean age not provided), focused on the clinical implications of high weight gain post-Fontan. They found that increasing weight during adulthood was independently associated with a combined endpoint of mortality, heart transplant, PLE, VO 2 <50%, and new use of a loop diuretic (HR 1.36, CI 1.07-1.73; P = 0.011).…”

Section: Weight Trajectory and Outcomesmentioning

confidence: 99%

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Associations between Bodyweight and Clinical Outcome in Patients Post-Fontan Procedure: A Systematic Review

Payne¹,

Wilson²,

Haghighi³

et al. 2022

Congenital Heart Disease

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Background: Patients born with a single ventricle circulation commonly experience growth failure in early life, which is associated with adverse outcomes in infancy. However, associations between bodyweight or weight trajectory and clinical outcome post-Fontan procedure are yet to be determined. Methods: On the 1st of July 2021, a systematic review was performed in MEDLINE, EMBASE, the Cochrane Library, and Scopus of studies of patients with clinical outcome data post-Fontan procedure and association with bodyweight. Quality of studies was evaluated by Newcastle-Ottawa scale for cohort studies and Joanna Briggs Institute tool for cross-sectional studies. Results: Of 527 studies that underwent title and abstract screening, 15 were selected for final review. An increased risk of adverse post-Fontan outcomes was found for low weight patients, consistent with findings in infants. Whilst there is some evidence to suggest increased mortality in overweight adult patients, studies are conflicting as to whether overweight status is associated with increased heart failure. Increased BMI is associated with diminished exercise capacity and deceased physiological functioning. Negative weight trajectory is associated with adverse outcomes in the peri-Fontan period, whereas a positive weight trajectory is associated with increased Fontan failure in adulthood. Abnormal BMI (high or low) is associated with increased heart failure and poorer performance in quality-of-life scores. Conclusions: Bodyweight is a modifiable risk factor for poor clinical outcome in patients with a single ventricle circulation. Recognizing associations between bodyweight and Fontan pathophysiology may help to define patient-centered exercise and diet interventions that minimize patient morbidity and mortality.

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Section: Bmi-associated Patient Factorsmentioning

confidence: 79%

Section: Impact Of Overweight On Physiological Parametersmentioning

confidence: 94%

Section: Bmi-associated Patient Factorsmentioning

confidence: 99%

Section: Weight Trajectory and Outcomesmentioning

confidence: 99%

See 2 more Smart Citations

Associations between Bodyweight and Clinical Outcome in Patients Post-Fontan Procedure: A Systematic Review

Payne¹,

Wilson²,

Haghighi³

et al. 2022

Congenital Heart Disease

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“…Indeed, this type of diet is proven to optimize cardiovascular health [ 94 ]. It is of detrimental importance to prevent obesity in people with FC, as a higher BMI has been associated with symptomatic heart failure and higher mortality in a cohort of adult patients [ 95 ]; in fact, obesity may worsen chronic myocardial dysfunction and/or residual anatomic lesions and increase the risk of Fontan failure [ 96 ]. For these reasons, we suggest regularly monitoring MUAC and performing a bioimpedance analysis during follow-up.…”

Section: Nutritional Management After Fontan Surgerymentioning

confidence: 99%

Nutritional Management of Patients with Fontan Circulation: A Potential for Improved Outcomes from Birth to Adulthood

et al. 2022

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Fontan circulation (FC) is a surgically achieved palliation state offered to patients affected by a wide variety of congenital heart defects (CHDs) that are grouped under the name of univentricular heart. The procedure includes three different surgical stages. Malnutrition is a matter of concern in any phase of life for these children, often leading to longer hospital stays, higher mortality rates, and a higher risk of adverse neurodevelopmental and growth outcomes. Notwithstanding the relevance of proper nutrition for this subset of patients, specific guidelines on the matter are lacking. In this review, we aim to analyze the role of an adequate form of nutritional support in patients with FC throughout the different stages of their lives, in order to provide a practical approach to appropriate nutritional management. Firstly, the burden of faltering growth in patients with univentricular heart is analyzed, focusing on the pathogenesis of malnutrition, its detection and evaluation. Secondly, we summarize the nutritional issues of each life phase of a Fontan patient from birth to adulthood. Finally, we highlight the challenges of nutritional management in patients with failing Fontan.

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