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Early and intermediate-term (10-year) results of surgery for univentricular atrioventricular connection ("single
Insights
Surgical outcomes for single ventricle patients show a 10-year survival of 66%. Specific procedures like classic shunting and ventricular septation offer improved survival rates, with most survivors in good functional class.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiovascular Surgery
Background:
- Single ventricle physiology presents complex surgical challenges.
- Long-term outcomes for these patients have historically been poor.
- Advancements in surgical techniques are crucial for improving survival and quality of life.
Purpose of the Study:
- To evaluate the long-term survival and functional outcomes of patients with single ventricle.
- To assess the efficacy of different surgical procedures for single ventricle palliation.
- To identify risk factors associated with mortality in single ventricle patients.
Main Methods:
- Retrospective analysis of 116 patients with single ventricle undergoing 147 operations.
- Data collected between 1967 and 1983, including hospital deaths and late survival.
- Evaluation of outcomes for primary "classic" shunting, atrial septectomy, pulmonary artery banding, ventricular septation, and Fontan-type procedures.
Main Results:
- Overall 10-year actuarial survival was 66%.
- Primary "classic" shunting had a 10-year survival of 85% with 2% hospital mortality.
- Ventricular septation had a 36% hospital mortality, but ideal candidates had 77% late survival. Fontan-type procedures had 22% hospital mortality and 71% 10-year survival.
- Cardiac morphology, other than tricuspid atresia, was a risk factor for hospital death in Fontan-type procedures.
- 97% of surviving patients were in New York Heart Association functional class I or II.
Conclusions:
- Surgical interventions for single ventricle can achieve significant long-term survival.
- Specific procedures like ventricular septation and Fontan-type procedures show promising results, particularly in carefully selected patients.
- Most survivors achieve good functional status, highlighting the importance of tailored surgical approaches.
Abstract:
One hundred sixteen patients with "single ventricle" underwent 147 operations between 1967 and July 1982, with an actuarial survival rate (hospital deaths are included in all actuarials) at 10 years of 66%. One hospital death (2%) occurred after 45 primary "classic" shunting operations, and the 10-year actuarial survival was 85%. There were no hospital deaths after atrial septectomy or pulmonary artery banding, and the 10-year actuarial survival rate after these as initial procedures was 76% and 74%, respectively. Thirteen of 36 patients (36%) who underwent ventricular septation between 1967 and November 1, 1983, died in hospital. Among the 13 with the ideal morphologic characteristics of double inlet left ventricle without major associated cardiac anomalies, and without the need for valve replacement or a valved extracardiac conduit, there were no hospital deaths and a late survival rate of 77% (confidence limits 59 to 90%). Sixteen of 73 patients (22%), including those with tricuspid atresia, undergoing the Fontan-type procedure between 1967 and November 1, 1983, died in hospital. Multivariate analysis indicates that cardiac morphologic patterns other than tricuspid atresia are risk factors for hospital death in this group. The 10-year actuarial survival rate among the 73 patients was 71%, but only 1 death (associated with reoperation) occurred more than 2 months after operation. Ninety-seven percent of all surviving patients are in New York Heart Association functional class I or II, as are 100% of those who underwent septation and 96% of those who underwent the Fontan-type procedure.