Outcome of biventricular repair of congenital cardiac malformations with a borderline left ventricle.

INTRODUCTION

Biventricular repairs are occasionally done on hearts with a borderline-sized left ventricle to avoid univentricular palliation. We aim to assess the outcome.

MATERIALS AND

METHODS

Data of 27 patients with borderline left ventricle that had undergone biventricular repair in our centers in the past 20 years (median follow-up: 5 years) were analyzed retrospectively.

RESULTS

Successful primary repair was performed in 17 (63%) patients. Four (15%) patients initially underwent primary repairs, which were converted to Norwood reconstructions, hoping to re-attempt biventricular repair later. Primary Norwood reconstruction with a restrictive atrial septal defect or its hybrid equivalent were performed in 6 patients (2 Norwoods [7%], 4 Hybrids [15%]) for ventricular rehabilitation, with subsequent biventricular repair a few months later. The total number of procedures was 87 (average: 3.2 per patient). These figures do not include procedures for implantation of ECMO, re-operations for bleeding and delayed sternal closures because we consider these as parts of the procedures that immediately preceded them. This strategy failed in 8 (30%) patients: 7 died (4 within 1 year, 1 at 18 months, 1 at 3 years, 1 at 3.5 years), and 1 was converted to univentricular palliation eventually reaching Fontan completion. Four (15%) patients reached favorable outcomes: alive and asymptomatic with biventricular circulation, good ventricular function and normal-sized valves. The remaining 15 (55%) patients are alive but with residual lesions, which may include ventricular diastolic dysfunction, somewhat small mitral and/or aortic valves and pulmonary hypertension; 9 are in NYHA class I and 6 in class II.

CONCLUSION

The results are suboptimal. Further studies are needed to identify ways of predicting who would benefit most from aggressively pursuing a biventricular strategy and offer it to them selectively.