Contemporary Outcomes for Superior Cavopulmonary Connection in Single Ventricle Palliation: Is There Room for Improvement?

The superior cavopulmonary connection (SCPC) is performed as a part of staged palliation for single ventricle disease. With improvements in interstage management and patient selection, the attrition rate following SCPC is less than 10% in the modern era. We sought to examine the trends and outcomes of SCPC at our institution over the past 14 years. A retrospective review was conducted of patients who underwent SCPC at our institution from 2007 to 2020. Patients were divided into two groups based on date of surgery-pre- 2014 (2007-201) and 2014 + (2014-2020). Demographic and clinical characteristics were compared, along with follow-up survival data. Five hundred and fifty two patients underwent SCPC during the study period, of whom 306 (55.4%) were in the 2014 + era. Patients in the 2014 + era were more likely to be African American (40.2% vs. 31.7%, p = 0.02) or have a genetic abnormality (28.4% vs. 20.6%, p = 0.04). On preoperative echocardiogram, 2014 + patients had more significant (≥ moderate) atrioventricular valve regurgitation (AVVR) (19.6 vs. 10.6%, p = 0.003). Operative and interstage mortality did not differ between eras (p > 0.05). In addition, there was no difference in long-term survival (HR 0.66 [CI 0.34-1.29], p = 0.22) between groups. On multivariable analysis, only ≥ moderate ventricular dysfunction (HR 4.23 [CI 1.18-12.02], p = 0.01) and hypoplastic pulmonary arteries (HR 3.03 [CI 1.17-10.36], p = 0.04) were associated with lower survival. Overall survival following SCPC is excellent, with no improvement in survival in the 2014 + era. More patients with high-risk factors-genetic syndromes and significant AVVR-were operated on in the recent era, without an adverse effect on survival.