{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T05:09:01Z","timestamp":1778735341377,"version":"3.51.4"},"reference-count":27,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"General Guidance Project of Health Science and Technology of Guangzhou Municipal Health Commission","award":["20251A011033"],"award-info":[{"award-number":["20251A011033"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>(1) Background: Exercise intolerance is a nearly ubiquitous consequence among patients who have undergone the total cavopulmonary connection (TCPC) or modified Fontan procedure; however, the specific factors influencing this condition\u2014especially the impact of surgical timing and perioperative management\u2014remain inadequately understood. (2) Methods: From a retrospective cohort of 255 TCPC patients, 99 who had undergone cardiopulmonary exercise testing (CPET) were included. Patients were stratified into a normal exercise tolerance group (ET group, peak VO2 \u2265 80% predicted, n = 45) and an exercise intolerance group (EI group, peak VO2 &lt; 80% predicted, n = 54). Univariate and multivariate logistic regression analyses were performed to identify risk factors for decreased exercise tolerance. (3) Results: Patients in EI group were older at TCPC surgery (4.67 vs. 3.60 years, p = 0.004) and CPET (10.11 vs. 8.65 years, p = 0.01). They had longer operation time (312.14 vs. 267.53 min, p = 0.01), bypass time (122.26 vs. 103.59 min, p = 0.045), and higher rate of prolonged ICU stay (&gt;3 days, 68.9% vs. 31.1%, p = 0.01). ROC analysis determined optimal surgical age cut-off at 3.81 years (AUC = 0.692, p = 0.001). Univariate analysis identified age \u2265 3.8 years, ICU stay &gt; 3 days, longer operation\/bypass times, and postoperative atrioventricular valve regurgitation as significant risk factors. Multivariate analysis confirmed age at TCPC \u22653.8 years (OR = 2.54, 95% CI: 1.01\u20136.42, p = 0.049) and ICU stay &gt;3 days (OR = 2.61, 95% CI: 1.07\u20136.39, p = 0.04) as independent predictors of exercise intolerance. (4) Conclusions: The delayed completion (beyond 3.8 years of age) of TCPC procedure and the occurrence of early postoperative complications are associated with reduced long-term exercise capacity.<\/jats:p>","DOI":"10.3390\/jcdd13050188","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T15:01:18Z","timestamp":1777474878000},"page":"188","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk Factors of Exercise Intolerance in Children and Adolescents After Total Cavopulmonary Connection"],"prefix":"10.3390","volume":"13","author":[{"given":"Xuwen","family":"Xiao","sequence":"first","affiliation":[{"name":"Medical Education Center of Jinan University, Jinan University, Guangzhou 510632, China"},{"name":"Department of Surgical Intensive Care Unit (SICU), Guangzhou Women and Children\u2019s Medical Center, Guangzhou Medical University, Guangzhou 510623, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ge","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Surgical Intensive Care Unit (SICU), Guangzhou Women and Children\u2019s Medical Center, Guangzhou Medical University, Guangzhou 510623, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haifan","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Surgical Intensive Care Unit (SICU), Guangzhou Women and Children\u2019s Medical Center, Guangzhou Medical University, Guangzhou 510623, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaowei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Surgical Intensive Care Unit (SICU), Guangzhou Women and Children\u2019s Medical Center, Guangzhou Medical University, Guangzhou 510623, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min","family":"Tong","sequence":"additional","affiliation":[{"name":"Department of Surgical Intensive Care Unit (SICU), Guangzhou Women and Children\u2019s Medical Center, Guangzhou Medical University, Guangzhou 510623, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruyin","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Surgical Intensive Care Unit (SICU), Guangzhou Women and Children\u2019s Medical Center, Guangzhou Medical University, Guangzhou 510623, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yixin","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Surgical Intensive Care Unit (SICU), Guangzhou Women and Children\u2019s Medical Center, Guangzhou Medical University, Guangzhou 510623, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ma","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiac Intensive Care Unit (CICU), Guangzhou Women and Children\u2019s Medical Center, Guangzhou Medical University, Guangzhou 510623, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanqin","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Surgical Intensive Care Unit (SICU), Guangzhou Women and Children\u2019s Medical Center, Guangzhou Medical University, Guangzhou 510623, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1136\/thx.26.3.240","article-title":"Surgical repair of tricuspid atresia","volume":"26","author":"Fontan","year":"1971","journal-title":"Thorax"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s12968-018-0505-4","article-title":"Maldistribution of pulmonary blood flow in patients after the Fontan operation is associated with worse exercise capacity","volume":"20","author":"Alsaied","year":"2018","journal-title":"J. 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