Optimizing outcomes for patients undergoing superior cavopulmonary connection procedure: what we know.

The Superior cavopulmonary connection (SCPC) is typically the second stage of the single ventricle palliation. There are modifiable factors that have a complex interplay in determining outcomes such as mortality or hospital length of stay. There is no clear consensus on the timing of SCPC as this involves a critical balance between the timing of operation and the length of the high-risk interstage period. Younger age has not been associated with reduced transplant-free survival but has been associated with longer hospital length of stay. Another critical decision is for children with viral respiratory infections; a patient with a symptomatic viral respiratory infection may need to be delayed for weeks but this extends time in the interstage. While age is an important consideration, weight-for-age-Z-score and rate of weight gain are also critical factors in reduced transplant-free survival with those poor weight gain. Atrioventricular valve regurgitation, pulmonary artery obstruction and arch obstruction can all impact outcomes of SCPC. A systematic approach to pre-operative evaluation can identify these residual lesions to individualize the approach and optimize outcomes of single ventricle palliation.