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Early and late results after correction for double-outlet right ventricle: uni- and multivariate analysis of risk
1Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
Insights
Total correction for double-outlet right ventricle improved significantly after 1980, with reduced hospital mortality and improved long-term survival. Key factors influencing mortality included myocardial protection strategies and cardiopulmonary bypass duration.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
Background:
- Double-outlet right ventricle (DORV) is a complex congenital heart defect.
- Surgical correction outcomes for DORV have evolved over time.
- Understanding long-term results and risk factors is crucial for patient management.
Purpose of the Study:
- To evaluate the long-term outcomes of total correction for DORV.
- To identify predictors of hospital mortality and reoperation.
- To assess functional status and survival rates post-correction.
Main Methods:
- Retrospective analysis of 59 patients undergoing total correction for DORV between April 1968 and May 1991.
- Assessment of hospital mortality, late death rate, reoperation rates, and actuarial survival.
- Univariate and multivariate analyses to identify predictors of mortality, including myocardial protection and cardiopulmonary bypass time.
Main Results:
- Hospital mortality decreased significantly from 41% before 1980 to 13% thereafter.
- Actuarial survival was 67% at 10 and 20 years; reoperation rate was 42%, mainly for VSD patch issues.
- Low cardiac output failure was the leading cause of early death; prolonged cardiopulmonary bypass and lack of cardioplegia predicted mortality.
Conclusions:
- Total correction for DORV has shown improved outcomes, particularly after 1980.
- Myocardial protection strategies and cardiopulmonary bypass duration are critical factors influencing surgical mortality.
- Long-term survivors demonstrate good functional status and normal left ventricular ejection fraction in most cases.
Abstract:
Between April 68 and May 91, 59 patients underwent total correction for double-outlet right ventricle. The mean age was 59.2 +/- 7.8 months. The hospital mortality rate was 27%; it was 41% before 1980 and 13% thereafter. Low cardiac output failure was the leading cause of early death. Myocardial protection without cardioplegia and long cardiopulmonary bypass time were significant predictors of hospital mortality in univariate as well as in multivariate analysis. The late death rate was 7%. The actuarial survival rate was 67% (CL 55-80%) after 10 and 20 years. The reoperation rate was 42%, a loose VSD patch constituted the main indication (23%). The actuarial freedom from reoperation rate was 51% (CL 33%-69%) after 10 years and 31% (12%-50%) after 20 years. The mean follow-up time was 8.4 +/- 0.9 years (2 to 20 years). Seventy-five percent of all postoperative survivors are in NYHA functional class I and left ventricular ejection fraction is normal in 82%.