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Article

Cardiac Function and Serum Biomarkers throughout Staged Fontan Palliation: A Prospective Observational Study

by
J. P. G. van der Ven
1,2,3,
V P. Kamphuis
2,4,
E van den Bosch
1,2,
D Gnanam
1,
C Terol
4,
A J. J. C. Bogers
3,
J. M. P. J. Breur
5,
R. M. F. Berger
6,
N. A. Blom
4,7,
A. D. J. ten Harkel
4,
L. Koopman
1 and
W. A. Helbing
1,*
1
Division of Pediatric Cardiology, Department of Pediatrics, Erasmus MC Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands
2
Netherlands Heart Institute, 3501 DG Utrecht, The Netherlands
3
Department of Cardiothoracic Surgery, Erasmus MC, 3015 CN Rotterdam, The Netherlands
4
Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, 2300 RA Leiden, The Netherlands
5
Division of Pediatric Cardiology, Department of Pediatrics, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
6
Division of Pediatric Cardiology, Department of Pediatrics, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
7
Division of Pediatric Cardiology, Department of Pediatrics, Amsterdam University Medical Center, 1007 MB Amsterdam, The Netherlands
*
Author to whom correspondence should be addressed.
J. Cardiovasc. Dev. Dis. 2023, 10(7), 289; https://doi.org/10.3390/jcdd10070289
Submission received: 10 May 2023 / Revised: 4 July 2023 / Accepted: 5 July 2023 / Published: 7 July 2023
(This article belongs to the Special Issue Echocardiography in Pediatric Heart Disease)
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Abstract

Fontan patients undergo multiple cardiothoracic surgeries in childhood. Following these procedures, ventricular function is temporarily decreased, and recovers over months. This is presumably related to cardiopulmonary bypass, but this is incompletely understood. Throughout the Fontan palliation, cardiac function is also affected by volume unloading. We aimed to gain insight into the biological processes related to impaired ventricular function and recovery following Fontan palliations using a panel of biomarkers. Furthermore, we described changes in ventricular function across the Fontan palliation due to volume unloading. We performed a prospective multicenter observational study in patients undergoing partial (PCPC) or total cavo-pulmonary connection (TCPC). Patients underwent assessment—including echocardiography and blood sampling—before surgery (T1), at first follow-up (T2), and 1 year after their procedures (T3). Blood samples were analyzed using a biomarker panel (OLINK CVD-III). Ninety-two biomarkers were expressed as principal components (PC) to limit multiple statistical testing. We included 32 PCPC patients aged 7.2 [5.3–10.3] months, and 28 TCPC patients aged 2.7 [2.2–3.8] years. The single ventricular longitudinal strain (SV GLS) temporarily decreased for PCPC patients at T2 (−15.1 ± 5.6 (T1) to −13.5 ± 5.2 (T2) to −17.3 ± 4.5 (T3), p < 0.047 for all differences), but not following TCPC. The serum biomarkers were expressed as 4 PCs. PC1, including biomarkers of cell–cell adhesion, was not related to any patient characteristic. PC2, including biomarkers of superoxide anion regulation, increased at T2. PC3, including biomarkers of cardiovascular development, related to the stage of Fontan palliation. PC4 was of uncertain biological or clinical significance. No PC was found that related to ventricular performance. The SV GLS was temporarily diminished following PCPC, but not following TCPC. Several biomarkers were related to post-operative stress and adaptation to the PCPC or TCPC circulation, but none were related to the outcome.
Keywords: congenital heart disease; Fontan palliation; single ventricle; biomarkers congenital heart disease; Fontan palliation; single ventricle; biomarkers

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MDPI and ACS Style

van der Ven, J.P.G.; Kamphuis, V.P.; van den Bosch, E.; Gnanam, D.; Terol, C.; Bogers, A.J.J.C.; Breur, J.M.P.J.; Berger, R.M.F.; Blom, N.A.; ten Harkel, A.D.J.; et al. Cardiac Function and Serum Biomarkers throughout Staged Fontan Palliation: A Prospective Observational Study. J. Cardiovasc. Dev. Dis. 2023, 10, 289. https://doi.org/10.3390/jcdd10070289

AMA Style

van der Ven JPG, Kamphuis VP, van den Bosch E, Gnanam D, Terol C, Bogers AJJC, Breur JMPJ, Berger RMF, Blom NA, ten Harkel ADJ, et al. Cardiac Function and Serum Biomarkers throughout Staged Fontan Palliation: A Prospective Observational Study. Journal of Cardiovascular Development and Disease. 2023; 10(7):289. https://doi.org/10.3390/jcdd10070289

Chicago/Turabian Style

van der Ven, J. P. G., V P. Kamphuis, E van den Bosch, D Gnanam, C Terol, A J. J. C. Bogers, J. M. P. J. Breur, R. M. F. Berger, N. A. Blom, A. D. J. ten Harkel, and et al. 2023. "Cardiac Function and Serum Biomarkers throughout Staged Fontan Palliation: A Prospective Observational Study" Journal of Cardiovascular Development and Disease 10, no. 7: 289. https://doi.org/10.3390/jcdd10070289

APA Style

van der Ven, J. P. G., Kamphuis, V. P., van den Bosch, E., Gnanam, D., Terol, C., Bogers, A. J. J. C., Breur, J. M. P. J., Berger, R. M. F., Blom, N. A., ten Harkel, A. D. J., Koopman, L., & Helbing, W. A. (2023). Cardiac Function and Serum Biomarkers throughout Staged Fontan Palliation: A Prospective Observational Study. Journal of Cardiovascular Development and Disease, 10(7), 289. https://doi.org/10.3390/jcdd10070289

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