Cardiopulmonary Exercise Testing—A Valuable Tool, Not Gatekeeper When Referring Patients With Adult Congenital Heart Disease for Transplant Evaluation

Jonathan N. Menachem, Nosheen Reza, Jeremy A. Mazurek, Danielle Burstein, Edo Y. Birati, Arieh Fox, Yuli Y. Kim, Maria Molina, Sara L. Partington, Monique Tanna, Lynda Tobin, Joyce Wald, Lee R. Goldberg

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Introduction: Treatment of patients with adult congenital heart disease (ACHD) with advanced therapies including heart transplant (HT) is often delayed due to paucity of objective prognostic markers for the severity of heart failure (HF). While the utility of Cardiopulmonary Exercise Testing (CPET) in non-ACHD patients has been well-defined as it relates to prognosis, CPET for this purpose in ACHD is still under investigation. Methods: We performed a retrospective cohort study of 20 consecutive patients with ACHD who underwent HT between March 2010 and February 2016. Only 12 of 20 patients underwent CPET prior to transplantation. Demographics, standard measures of CPET interpretation, and 30-day and 1-year post transplantation outcomes were collected. Results: Patient Characteristics. Twenty patients with ACHD were transplanted at a median of 40 years of age (range: 23-57 years). Of the 12 patients who underwent CPET, 4 had undergone Fontan procedures, 4 had tetralogy of Fallot, 3 had d-transposition of the great arteries, and 1 had Ebstein anomaly. Thirty-day and one-year survival was 100%. All tests included in the analysis had a peak respiratory quotient _1.0. The median peak oxygen consumption per unit time (_VO2) for all diagnoses was 18.2 mL/kg/min (46% predicted), ranging from 12.2 to 22.6. Conclusion: There is a paucity of data to support best practices for patients with ACHD requiring transplantation. While it cannot be proven based on available data, it could be inferred that outcomes would have been worse or perhaps life sustaining options unavailable if providers delayed referral because of the lack of attainment of CPET-specific thresholds.

Original languageEnglish
Pages (from-to)286-291
Number of pages6
JournalWorld journal for pediatric & congenital heart surgery
Volume10
Issue number3
DOIs
StatePublished - 1 May 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© The Author(s) 2019.

Keywords

  • Fontan
  • congenital heart disease (CHD)
  • heart
  • morbidity)
  • outcomes (includes mortality
  • transplantation

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