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

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Congenital cardiac surgery has seen remarkable progress over 40 years, with survival rates improving dramatically.
• Single ventricle (SV) physiology presents ongoing challenges, with higher morbidity and mortality compared to biventricular patients.
• Established databases like STS and EACTS track outcomes, reflecting significant advancements in patient care pathways.

Purpose of the Study:

• To highlight key advancements in the care of patients with single ventricles (SVs).
• To discuss the evolution of care processes at a single center for SV patients.
• To explore future areas for improvement in SV management, including mechanical support and transplantation.

Main Methods:

• Review of historical data and current practices in congenital cardiac surgery.
• Analysis of outcomes for single ventricle patient cohorts.
• Focus on the role of mechanical circulatory support and heart transplantation in SV management.

Main Results:

• Overall survival in congenital cardiac surgery has improved to near-expected program mortalities of 2%.
• Despite improvements, single ventricle patients continue to experience higher morbidity and mortality than biventricular patients.
• Mechanical support and transplantation are critical components of comprehensive SV care.

Conclusions:

• Continued advancements in surgical techniques and comprehensive care pathways have transformed congenital cardiac surgery outcomes.
• Further research and innovation are needed to optimize outcomes for single ventricle patients.
• A multidisciplinary approach focusing on mechanical support and transplantation is essential for improving the long-term prognosis of SV disease.