A Preoperative Estimate of Central Venous Pressure Is Associated with Early Fontan Failure

Objective Early Fontan Failure (EFF) is a serious complication following total cavopulmonary connection (TCPC), characterised by high central venous pressure (CVP), low cardiac output and resistance to medical therapy. This study aimed to estimate post-operative CVP in TCPC patients (CVP TCPC ) using data routinely collected during pre-operative assessment. We sought to determine if this metric correlated with measured post-operative CVP and if it was associated with EFF. Methods In this retrospective study, CVP TCPC was estimated in 131 patients undergoing pre-TCPC assessment by cardiac magnetic resonance imaging and CVP measurement under general anaesthesia. Post-operative CVP during the first 24hours in ICU was collected from electronic patient records in a subset of patients. EFF was defined as death, transplantation, TCPC takedown or emergency fenestration within the first 30days. Results Estimated CVP TCPC correlated significantly with CVP ICU (r=0.26, p=0.03), particularly in patients without a fenestration (r=0.45, p=0.01). CVP TCPC was significantly associated with EFF (Odds Ratio [OR] 1.12 (1.02-1.24), p=0.02). A threshold of CVP TCPC ≥33mmHg was found to have the highest specificity (90%) and sensitivity (67%) for identifying EFF (area under receiver operating curve, AUC = 0.79), OR 18.8 (3.1-114), p=0.001. This association was stronger in patients with single SVCs. Conclusions Estimated CVP TCPC is an easily calculated metric combining pre-operative pressure and flow data. Higher CVP TCPC is associated with an increased risk of EFF and is correlated with directly measured post-TCPC pressure. Identification of patients at risk of EFF has the potential to guide risk mitigation strategies.