Mortality and Health Outcomes in North Carolina Communities Located in Close Proximity to Hog Concentrated Animal Feeding Operations

Abstract

### 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.