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Biventricular Conversion in Unseptatable Hearts: "Ventricular Switch".

Hani K Najm1, Tara Karamlou1, Munir Ahmad1

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Summary
This summary is machine-generated.

This study introduces a novel "ventricular switch" technique for complex heart defects, successfully using the left ventricle as the subpulmonary ventricle. This biventricular repair improves oxygen saturation and functional status in previously "unseptatable" patients.

Keywords:
DORVHeterotaxyVentricular switch

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Area of Science:

  • Pediatric Cardiac Surgery
  • Congenital Heart Disease Repair
  • Advanced Cardiovascular Interventions

Background:

  • Complex congenital heart defects with challenging anatomy were traditionally treated with univentricular palliation.
  • These patients, often labeled "unseptatable," face severe cyanosis and functional limitations.
  • Existing surgical options for these complex cases are limited, necessitating innovative approaches.

Purpose of the Study:

  • To describe the initial experience with a novel septation/biventricular conversion technique.
  • To utilize the left ventricle (LV) as the subpulmonary ventricle in patients with complex heart anatomy.
  • To evaluate the feasibility and outcomes of this approach in previously "unseptatable" patients.

Main Methods:

  • Five consecutive patients with complex systemic and pulmonary venous anatomy underwent biventricular conversion.
  • The strategy involved utilizing the morphologic LV as the subpulmonary ventricle, mimicking congenitally corrected transposition.
  • Three-dimensional printed heart models were used to assess surgical feasibility; complex atrial septation was performed as needed.

Main Results:

  • All five patients survived the procedure with a median follow-up of 0.6 years.
  • Left ventricular recruitment significantly improved systemic oxygen saturation (79% to 95%) and functional status.
  • Median hospital stay was 13 days, with patients often having undergone multiple prior cardiac surgeries.

Conclusions:

  • A novel paradigm for biventricular repair using the LV as the subpulmonary ventricle is effective in complex, 'unseptatable' heart defects.
  • This 'ventricular switch' approach offers a versatile alternative to univentricular palliation.
  • Earlier intervention with this strategy may lead to optimal long-term outcomes.