Quality of Life Assessment Following Direct Total Cavopulmonary Connection in Fontan Circulation: A Single Center Cross-Sectional Study

Background: This study aims to compare the long-term outcomes and quality of survival between the direct total cavopulmonary connection (dTCPC) procedure and the standard extracardiac conduit (ECC) procedure in Fontan patients. Methods: A total of 31 participants who underwent the Fontan operation with either ECC (n = 15) or dTCPC (n = 16) at our institution were recruited between May 2023 and October 2023. Comprehensive evaluations included physical examinations, blood tests, targeted plasma metabolomics assays, cardiopulmonary exercise testing (CPET), and cardiac magnetic resonance imaging (CMR). Data collected from these assessments were analyzed and compared between the two groups. Results: The mean follow-up duration was longer in the dTCPC group (174.25 ± 63.06 months) compared to the ECC group (144.00 ± 43.70 months). No significant differences were observed in blood test parameters between the groups (p > 0.05). During CPET, two patients in the dTCPC group (12.5%) terminated the experiment due to a sudden decrease in exercise tolerance during the cycling process. Peak VO2 values were comparable between groups, with 20.29 ± 7.40 mL/min/kg in the dTCPC group versus 19.10 ± 7.93 mL/min/kg in the ECC group (p = 0.5939). Cardiac output in CMR revealed no significant differences between the two groups (5.28 ± 3.20 vs. 5.40 ± 2.85, p > 0.05). Additionally, flow measurements within the Fontan structure showed no significant differences (2.042 ± 1.0 vs. 2.023 ± 1.0], p > 0.05). Plasma metabolic profiling using targeted metabolomics demonstrated that the metabolic profiles of the two groups were broadly similar. Conclusions: The dTCPC procedure demonstrated similar outcomes to the ECC procedure in terms of exercise cardiopulmonary function, blood flow in central great vessels and plasma metabolic profiles. However, the long-term survival quality following dTCPC surgery, particularly regarding exercise capacity, may not fully meet expectations, highlighting the need for further refinement in surgical techniques and postoperative management.