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Survival in patients with univentricular hearts: the impact of right versus left ventricular morphology

Gunnar Erikssen1, Jamil Aboulhosn2, Jeannette Lin2

  • 1ACHD Unit, Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.

Open Heart
|October 27, 2018
PubMed

Insights

Single right ventricular (SRV) morphology is a significant predictor of mortality in patients with univentricular hearts (UVH), primarily due to heart failure. This finding holds true for SRV patients with or without hypoplastic left heart syndrome (HLHS).

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Congenital Heart Disease Research

Background:

  • Univentricular hearts (UVH) present a high mortality risk, necessitating improved patient stratification.
  • Distinguishing between single right ventricular (SRV) and single left ventricular (SLV) morphology is crucial for risk assessment.

Purpose of the Study:

  • To investigate the prognostic significance of SRV versus SLV morphology in patients with UVH.
  • To enhance risk stratification for UVH patients by analyzing ventricular morphology.

Main Methods:

  • A prospective study included 395 UVH patients operated between 1972 and 2016.
  • Data collected included UVH morphology, surgical procedures, and outcomes (death or heart transplantation - HTX).
  • Survival analysis compared SRV and SLV groups, considering heart failure as a cause of death/HTX.

Main Results:

  • SRV morphology was associated with significantly higher mortality/HTX rates compared to SLV in both non-Fontan and Fontan patient groups.
  • Heart failure was a more frequent cause of death/HTX in SRV patients.
  • SRV morphology strongly predicted adverse outcomes in multivariable analyses (RR 3.3).

Conclusions:

  • SRV morphology is a robust predictor of both short-term and long-term survival in UVH patients.
  • The increased mortality in SRV patients is primarily attributed to higher rates of heart failure.
  • These findings are applicable to SRV patients regardless of the presence of hypoplastic left heart syndrome (HLHS).
Abstract

Keywords:
congenital heart defectsheart surgerysurvivaluniventricular heartsventricular morphology

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