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Updated: Jan 7, 2026
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Published on: June 16, 2023
Primary biventricular repair in neonates with borderline left ventricle
Michael Bamgbose1, Pankaj Garg1, Meena Nathan1
1Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass.
Background:
Borderline left ventricle (LV) represents a spectrum of defects, from mild to severe left heart hypoplasia, often with other cardiac anomalies. Decision-making regarding primary biventricular (BiV) repair is challenging. We sought to identify risk factors associated with adverse outcome after neonatal primary BiV repair for borderline LV.
Methods:
A retrospective review was undertaken of neonatal primary BiV repair for borderline LV between 2001 and 2022. The primary outcome was composite of death, transplant, conversion to single-ventricle circulation, pulmonary vascular resistance ≥3 Wood units, and left atrial mean pressure >15 mm Hg. Logistic regression was used to identify associations. Secondary outcome was left heart reintervention (LHRI), analyzed using competing risk regression. Risk score to predict probability of composite outcome was developed.
Results:
Among 238 neonates, 133 (56%) were male. Median age was 6 (4-10) days. Median follow-up was 1.6 (0.3-5.5) years. The composite outcome occurred in 48 (20.2%) patients. In total, 62 (26.2%) patients required LHRI. Mitral valve area z score <-2 (adjusted hazard ratio [aHR], 3.09; 95% CI, 1.33-7.21; P = .009) and endocardial fibroelastosis (EFE) (aHR, 2.91; 95% CI, 1.08-7.87, P = .04) were associated with the composite outcome. LHRI was associated with mitral valve anterior-posterior diameter z score <-2 (aHR, 2.45; 95% CI, 1.27-4.72, P = .007) and EFE (aHR, 2.54; 95% CI, 1.09-5.91, P = .03). Risk scores ranged from 1 (18% predicted risk) to 4 (86% predicted risk).
Conclusions:
Mitral valve dimensions and EFE presence are associated with adverse outcomes after BiV repair and can guide frequency of surveillance. Risk stratification may assist with decision-making on initial management strategy.
