Predictors of Protein Losing Enteropathy after Fontan completion, a retrospective study from eight years’ experience in a growing high volume cardiac surgery center.

Abstract Background: Fontan procedure is the final stage of a three-stage palliation process in patients born with a univentricular heart as part of Hypoplastic Left Heart Syndrome (HLHS) or other types of Univentricular Heart. As essential as this procedure has proven to be for such cases, the Fontan physiology diminishes the cardiac output and expands systemic venous pressure which leads to venous congestion that can be complicated by Protein Losing Enteropathy (PLE). The aim of this retrospective research was to study the predictors of such complications in all patients who underwent completion of Fontan in our center in the past eight years. It involved the examination of medical records of patients who underwent completion of Fontan repair in our center since the inauguration of its cardiac surgery program. Exclusion criteria included the absence of any of the required predictors in a medical report. Included patients were divided into two groups: those who developed PLE and those who did not. For each group, the following data were collected: The degree of AV valve regurge, the ventricular functions, the invasive SVC, and pulmonary pressures before Fontan completion and the original cardiac diagnosis. Results: 48 patients were included: only 13 developed PLE, accounting for 25% of the total patients. A multivariate regression analysis of the best predictors of the occurrence of PLE was the degree of AV valve regurge (P = 0.008), SVC mean pressure (P value = 0.01), and Ventricular functions (P value = 0.02). A ROC analysis was performed for each of the best predictors and showed that SVC pressure > 11 was 100% sensitive, moderate and severe regurge were 69% sensitive, and moderate to severe impairment of ventricular functions was 53% sensitive in predicting subsequent PLE. Conclusion: The unleashed findings might be game-changing in the decision-making of whether to complete the Fontan pathway or not in our growing cardiac surgery center, which is one of the largest in its respective region. The presence of moderate to severe AV valve regurge, moderate to severe ventricular dysfunction, and a Superior Vena caval pressure above 11 before Fontan completion should be regarded as contraindications to completion of the procedure.