Staged Ventricular Recruitment and Biventricular Conversion Following Single-ventricle Palliation in Unbalanced Atrioventricular Canal Defects

Overview

Journal JTCVS Open

Specialty Cardiology & Vascular Diseases

Date 2023 Apr 17

PMID 37063136

Authors

Nicholas A Oh

Ilias P Doulamis

Alvise Guariento

Breanna Piekarski

Gerald R Marx

Pedro J Del Nido

Sitaram M Emani

Affiliations

Soon will be listed here.

Abstract

Objective: Restoration of biventricular circulation is an alternative management strategy in unbalanced atrioventricular canal defects (uAVCDs), especially in patients with risk factors for single-ventricle palliation (SVP) failure. When ventricular volume is inadequate for biventricular circulation, recruitment procedures may accommodate its growth. In this study, we review our uAVCD experience with biventricular conversion (BIVC) after prior SVP.

Methods: This is a single-institution, retrospective cohort study of uAVCD patients who underwent BIVC after SVP, with staged recruitment (staged) or primary BIVC (direct) between 2003 to 2018. Mortality, unplanned reinterventions, imaging, and catheterization data were analyzed.

Results: Sixty-five patients underwent BIVC from SVP (17 stage 1, 42 bidirectional Glenn, and 6 Fontan). Decision for conversion was based on poor SVP candidacy (n = 43) or 2 adequately sized ventricles (n = 22). Of the 65 patients, 20 patients underwent recruitment before conversion. The staged group had more severe ventricular hypoplasia than the direct group, reflected in prestaging end-diastolic volume scores (-4.0 vs -2.6; < .01), which significantly improved after recruitment (-4.0 to -1.8; < .01). Median follow-up time was 1.0 years. Survival and recatheterizations were similar between both groups (hazard ratio, 0.9; 95% CI, 0.2-3.7; = .95 and hazard ratio, 1.9; 95% CI, 0.9-4.1; = .09), but more reoperations occurred with staged approach (hazard ratio, 3.1; 95% CI, 1.3-7.1; = .01).

Conclusions: Biventricular conversion from SVP is an alternative strategy to manage uAVCD, particularly when risk factors for SVP failure are present. Severe forms of uAVCDs can be converted with staged BIVC with acceptable mortality, albeit increased reinterventions, when primary BIVC is not possible.

Citing Articles

Staged repair of borderline hypoplastic heart disease with early biventricular conversion.

Andersen N, Overbey D, Prabhu N, McCrary A, Sherwin J, Allareddy V JTCVS Tech. 2024; 24:150-163.

PMID: 38835569 PMC: 11145415. DOI: 10.1016/j.xjtc.2024.02.006.

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