Hemodynamic Profiling Using a Cardiac Index–Systemic Vascular Resistance Plot in Patients with Fontan Circulation

Background: Elevated Fontan pressure (FP) alone cannot fully predict clinical outcomes. We hypothesized that hemodynamic profiling using a cardiac index (CI)-systemic vascular resistance (SVR) plot could characterize clinical features and predict the prognosis of post-Fontan patients. Methods: We included post-Fontan patients who underwent cardiac catheterization at age < 10 years. Patients were classified into four categories: A, CI ≥ 3, SVR index (SVRI) ≥ 20; B, CI < 3, SVRI ≥ 20; C, CI ≥ 3, SVRI < 20; and D, CI < 3, SVRI < 20. The primary outcome was freedom from the combined endpoint: new onset of protein-losing enteropathy or plastic bronchitis, heart trans-plant, and death. Clinical and hemodynamic variables and freedom from the endpoint were compared between the hemodynamic categories and outcome predictors were evaluated. Results: Eighty-three patients were included. Median follow-up was 5.3 years. Category A/B/C/D consisted of 4/15/53/11 patients, respectively. All the patients in category A were New York Heart Association I/II and had a significantly lower pulmonary vascular resistance index (PVRI). Patients in category C had lower pulmonary/systemic blood flow. Patients in category D had a higher PVRI and had the poorest freedom from the endpoint (44% at 5 years). Elevated FP and category D were outcome predictors. Conclusions: CI-SVR plots was a novel adjunctive method for Fontan hemodynamic profiling.