Predictors of Survival After Single-Ventricle Palliation

Abstract

Considerable mortality is still observed during the first years of life among patients with single ventricle. RV dominance is the most important risk factor for death but only before BCPS.

The Impact of Dominant Ventricle Morphology on Palliation Outcomes of Single Ventricle Anomalies

“…There have been several advances in perioperative care, perfusion and surgical techniques, postoperative management, and home monitoring that have led to significant improvements in outcomes after the Norwood operation [6,13,14]. Despite the continued high operative death and interstage mortality, palliation outcomes of single ventricle patients with the Norwood operation seem to be comparable to patients with a BTS, as evident from our series and other reports [13][14][15][16][17][18].…”

“…However, the inferior outcomes of those patients were evident earlier, after the different stages of palliation [1][2][3][4][5][6][7]. It is plausible that the earlier manifestation of poor outcomes in patients with single ventricle anomalies and right dominant ventricle is because of the presence of volume load (BTS) or pressure load (PAB).…”

“…It is also possible that the inferior outcomes reported in patients with right dominant single ventricle were related to the majority of those patients having hypoplastic left heart syndrome, an anomaly associated with inferior palliation outcomes, especially in the older era [6,13]. There have been several advances in perioperative care, perfusion and surgical techniques, postoperative management, and home monitoring that have led to significant improvements in outcomes after the Norwood operation [6,13,14].…”

“…[1,2]. Right dominant ventricle morphology has been reported to be associated with worse single ventricle palliation outcomes, including hospital death, interstage mortality, and overall survival subsequent to Fontan [1][2][3][4][5][6][7].…”

Management of the Fontan circulation in the adult patient

“…However, the success of the Norwood palliation for HLHS will also impact on these survival figures. (149) Survival for patients with an atriopulmonary Fontan may improve by conversion to a TCPC type Fontan. (150) The associated improvement in fluid mechanics and reduction in arrhythmia burden are likely to lead to survival improvements, but the operation requires careful consideration.…”