Surgery of single ventricles in humanitarian practice: surgery for which patients?

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease Surgery
• Global Health Initiatives

Background:

• Single-ventricle heart conditions represent a complex group of congenital heart defects requiring specialized surgical intervention.
• Humanitarian medical missions face unique challenges in providing long-term care for these children.
• Evaluating the effectiveness of surgical interventions in resource-limited settings is crucial for improving patient outcomes.

Purpose of the Study:

• To assess the feasibility and effectiveness of surgical interventions for children with single-ventricle heart conditions within a humanitarian context.
• To analyze long-term survival rates and outcomes following various surgical procedures.
• To identify factors influencing prognosis in this patient population.

Main Methods:

• Retrospective analysis of 138 children with single-ventricle physiology managed by Mécénat-Chirurgie Cardiaque since 1996.
• Inclusion of patients with long-term follow-up after returning to their home countries.
• Categorization of surgical procedures including palliative surgery, partial, and total cavopulmonary connections.

Main Results:

• 119 children underwent 180 surgical procedures, with an operative mortality of 5.5%.
• Ten-year survival was 79% for surgically treated patients versus 29% for non-surgically managed children (p<0.001).
• Specific conditions like tricuspid atresia and double-inlet left ventricle showed better prognoses (83-86% 10-year survival).

Conclusions:

• Surgical management of single-ventricle heart disease in humanitarian settings yields highly satisfactory survival rates.
• A trend towards earlier total cavopulmonary connection is associated with improved long-term outcomes.
• Humanitarian surgical programs can effectively improve the prognosis for children with complex congenital heart defects.