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Biventricular repair in neonates with hypoplastic left heart complex
C I Tchervenkov1, S A Tahta, L C Jutras
1Division of Cardiovascular Surgery, The Montreal Children's Hospital, McGill University, Quebec, Canada.
The Annals of Thoracic Surgery
|November 4, 1998
Summary
Biventricular repair for hypoplastic left heart complex in neonates shows a potential for favorable outcomes, though reoperations for left ventricular outflow tract obstruction are common. Further research will refine criteria for this complex surgical approach.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Neonatal Cardiology
Background:
- Multiple left heart-aorta obstructions are linked to poor survival in neonates.
- Current consensus is divided between univentricular and biventricular repair approaches for these complex cases.
Purpose of the Study:
- To evaluate the feasibility and outcomes of biventricular repair in neonates with hypoplastic left heart complex.
- To assess the need for reoperation and long-term survival following this surgical strategy.
Main Methods:
- Biventricular repair was performed on 11 neonates with hypoplastic left heart complex since 1988.
- Surgical techniques included extensive aortic reconstruction and elimination of intracardiac shunts.
- Echocardiographic data were reviewed to compare pre- and post-operative measurements.
Main Results:
- An 8-year actuarial survival rate of 63% was observed.
- Reoperations were required in 4 patients for left ventricular outflow tract obstruction and recurrent coarctation.
- Survivors are in New York Heart Association class I or II, indicating good functional status.
Conclusions:
- Biventricular repair can be successfully achieved in a subset of patients with hypoplastic left heart complex.
- Left ventricular growth was noted post-operatively.
- Reoperation, especially for left ventricular outflow tract obstruction, remains a significant concern, necessitating further refinement of surgical criteria.