Single ventricle care: challenges, successes and the future in a single center program

Congenital cardiac surgery has advanced considerably over the last 4 decades with improvements in virtually every aspect of care. Technical procedures are well described in literature and taught globally while expected results are published in databases such as the Society of Thoracic Surgery (STS) and European Association of Cardio-Thoracic Surgery (EACTS). Outcomes have progressed from uncertain survival to expected program mortalities of nearly 2%. This has been driven in part by advances in surgical technique, but also incremental improvements in the entire patient care pathway. Single ventricles (SVs) remain one of our most challenging cohorts of patients and our most resource intensive. Although outcomes have improved in the past decades, overall morbidity and mortality exceeds that of our biventricular patients. Our goal is to highlight some of the impactful advances surrounding SV care, discuss some of the ideology that led us to our current care processes as it applies to our single center program. We also discuss areas of improvement in the future. We have also focused on mechanical support and transplantation as it remains a keystone in SV care. We hope to provide insight into how to improve the care of patients born with SV disease.