Pharmacology Management in Improving Exercise Capacity of Patients with Fontan Circulation: A Systematic Review and Meta-analysis

Brian Mendel, Christianto, Moira Setiawan, Sisca Natalia Siagian, Radityo Prakoso

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: The Fontan procedure is currently the mainstay therapy for single functional ventricles. However, with prolonged follow-up duration, various complications have been observed that seriously influence the quality of life of patients. Objectives: The aim of this meta-analysis is to compare the effectiveness of pharmacologic agents in improving exercise capacity in patients with Fontan circulation. Methods: This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement and has been registered in the International Prospective Register for Systematic Reviews database with registration no. 282352. Quality as-sessments of the included studies were assessed using the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) statement. Results: Twelve studies met the predetermined inclusion criteria and were included in this meta-analysis. This meta-analysis found that treatment with bosentan significantly improved New York Heart Association Functional Class (NYHA FC) in Fontan patients (standard mean difference-0.59, 95% CI-0.94 –-0.25; P=0.0008; I2 = 1%). However, the use of bosentan (P=0.66) and sildenafil (P=0.13) did not show a significant improvement in the maximum rate of oxygen consumption (VO2 max). Conclusion: This meta-analysis shows that people with Fontan circulation may benefit from using bosentan as it decreases postexercise heart rate and improves NYHA FC and 6-minute walking test results. Therefore, indirectly improving exercise capacity. Nonetheless, considerable work is re-quired to strengthen our knowledge in improving the exercise capacity of Fontan patients.

Original languageEnglish
Article numbere040422203048
JournalCurrent Cardiology Reviews
Issue number5
Publication statusPublished - Sept 2022


  • Bosentan
  • exercise capacity
  • Fontan
  • patients
  • sildenafil
  • vasodilator


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