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The Incidence and Impact of Malnutrition in Patients with Fontan Physiology



Objective:

Single ventricle cardiac patients require a series of surgeries, with the final stage being the Fontan. This form of circulation results in a number of long-term complications but the impact on and consequences of nutritional status remain unclear. We sought to evaluate the incidence of malnutrition in Fontan patients and the impact on patient outcomes.


Methods:

Retrospective cohort study of all children who underwent Fontan surgery between 1997-2018. Clinical, demographic and nutritional data were collected including weight, height, BMI and their respective Z scores for age (WAZ, HAZ, BMIZ) pre-Fontan, at discharge, 6 months, and 1, 5, and 10 years post Fontan. Malnutrition status was categorized using the American Society of Parenteral and Enteral Nutrition guidelines and Michigan MTool. Fontan failure was defined as listing for heart transplant, or death.


Results:

Of the 69 patients, moderate-severe malnutrition occurred at any time point in 11% (n=8) by WAZ, 16% (n=11) by HAZ, and 6% (n=4) by BMIZ. Moderate-severe malnutrition persisted in 6.5-12.9% at 10 years post-Fontan with the highest proportion meeting criteria by HAZ. Compared to the pre-Fontan period, there was no change in these parameters over time. There was no statistically significant difference in Fontan failure between degrees of pre-Fontan malnutrition.


Conclusion:

There is a 6-16% incidence of moderate-severe malnutrition in Fontan patients. Malnutrition is a condition that remains present in longer-term follow-up. There was no association with anthropometric parameters and transplant free survival post-Fontan. A prospective multi-institutional study is needed to better understand the impact of malnutrition on long-term outcomes. This article is protected by copyright. All rights reserved.


Keywords:

Fontan; Malnutrition; Pediatrics; Single Ventricle Physiology.



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