Induction of aggressive arterial and venous dilation therapy in addition to pulmonary dilation therapy (super-Fontan strategy) improves Fontan circulation both at rest and during treadmill exerciseCentral MessagePerspective

Objective: Fontan circulation maintains preload and cardiac output by reducing venous capacitance and increasing central venous pressure (CVP). The resultant congestive end-organ damage affects patient prognosis. Therefore, a better circulatory management strategy to ameliorate organ congestion is r...

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Veröffentlicht in:JTCVS open 2022-09, Vol.11, p.388-397
Hauptverfasser: Shoichi Ishikawa, MD, Shun Matsumura, MD, PhD, Akiko Yana, MD, Clara Kurishima, MD, Yoichi Iwamoto, MD, PhD, Hirotaka Ishido, MD, PhD, Satoshi Masutani, MD, PhD, FAHA, Ryo Nakagawa, MD, PhD, Hideaki Senzaki, MD, PhD, FAHA
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Sprache:eng
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Zusammenfassung:Objective: Fontan circulation maintains preload and cardiac output by reducing venous capacitance and increasing central venous pressure (CVP). The resultant congestive end-organ damage affects patient prognosis. Therefore, a better circulatory management strategy to ameliorate organ congestion is required in patients with Fontan circulation. We sought to verify whether aggressive arterial and venous dilation therapy in addition to pulmonary dilation (super-Fontan strategy) can improve Fontan circulation and reduce congestion. Methods: Patients after Fontan surgery who received the super-Fontan strategy in a single center were recruited. Participants were examined using medical records between 2010 and 2018. We retrospectively analyzed the changes in hemodynamics at rest and during treadmill exercise before and after the introduction of this therapy. Results: The therapy significantly increased venous capacitance (3.21 ± 1.27 mL/kg/mm Hg to 3.79 ± 1.30 mL/kg/mm Hg, P = .017) and decreased total pulmonary resistance, leading to significantly reduced CVP (11.7 ± 2.4 mm Hg to 9.7 ± 2.2 mm Hg, P 
ISSN:2666-2736
2666-2736