Staged ventricular recruitment and biventricular conversion following single-ventricle palliation in unbalanced atrioventricular canal defectsCentral MessagePerspective
Objective: Restoration of biventricular circulation is an alternative management strategy in unbalanced atrioventricular canal defects (uAVCDs), especially in patients with risk factors for single-ventricle palliation (SVP) failure. When ventricular volume is inadequate for biventricular circulation...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S266627362200417X |
| _version_ | 1797860384592363520 |
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| author | Nicholas A. Oh, MD Ilias P. Doulamis, MD Alvise Guariento, MD Breanna Piekarski, BSN, RN Gerald R. Marx, MD Pedro J. del Nido, MD Sitaram M. Emani, MD |
| author_facet | Nicholas A. Oh, MD Ilias P. Doulamis, MD Alvise Guariento, MD Breanna Piekarski, BSN, RN Gerald R. Marx, MD Pedro J. del Nido, MD Sitaram M. Emani, MD |
| author_sort | Nicholas A. Oh, MD |
| collection | DOAJ |
| description | Objective: Restoration of biventricular circulation is an alternative management strategy in unbalanced atrioventricular canal defects (uAVCDs), especially in patients with risk factors for single-ventricle palliation (SVP) failure. When ventricular volume is inadequate for biventricular circulation, recruitment procedures may accommodate its growth. In this study, we review our uAVCD experience with biventricular conversion (BIVC) after prior SVP. Methods: This is a single-institution, retrospective cohort study of uAVCD patients who underwent BIVC after SVP, with staged recruitment (staged) or primary BIVC (direct) between 2003 to 2018. Mortality, unplanned reinterventions, imaging, and catheterization data were analyzed. Results: Sixty-five patients underwent BIVC from SVP (17 stage 1, 42 bidirectional Glenn, and 6 Fontan). Decision for conversion was based on poor SVP candidacy (n = 43) or 2 adequately sized ventricles (n = 22). Of the 65 patients, 20 patients underwent recruitment before conversion. The staged group had more severe ventricular hypoplasia than the direct group, reflected in prestaging end-diastolic volume z scores (–4.0 vs –2.6; P < .01), which significantly improved after recruitment (–4.0 to –1.8; P < .01). Median follow-up time was 1.0 years. Survival and recatheterizations were similar between both groups (hazard ratio, 0.9; 95% CI, 0.2-3.7; P = .95 and hazard ratio, 1.9; 95% CI, 0.9-4.1; P = .09), but more reoperations occurred with staged approach (hazard ratio, 3.1; 95% CI, 1.3-7.1; P = .01). Conclusions: Biventricular conversion from SVP is an alternative strategy to manage uAVCD, particularly when risk factors for SVP failure are present. Severe forms of uAVCDs can be converted with staged BIVC with acceptable mortality, albeit increased reinterventions, when primary BIVC is not possible. |
| first_indexed | 2024-04-09T21:45:00Z |
| format | Article |
| id | doaj.art-e333559843804fd88aad6936042834e3 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-04-09T21:45:00Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-e333559843804fd88aad6936042834e32023-03-25T05:15:31ZengElsevierJTCVS Open2666-27362023-03-0113278291Staged ventricular recruitment and biventricular conversion following single-ventricle palliation in unbalanced atrioventricular canal defectsCentral MessagePerspectiveNicholas A. Oh, MD0Ilias P. Doulamis, MD1Alvise Guariento, MD2Breanna Piekarski, BSN, RN3Gerald R. Marx, MD4Pedro J. del Nido, MD5Sitaram M. Emani, MD6Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass; Department of Cardiothoracic Surgery, Cleveland Clinic Foundation, Cleveland, OhioDepartment of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MassDepartment of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MassDepartment of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MassDepartment of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MassDepartment of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MassDepartment of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass; Address for reprints: Sitaram M. Emani, MD, Department of Cardiac Surgery, Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115.Objective: Restoration of biventricular circulation is an alternative management strategy in unbalanced atrioventricular canal defects (uAVCDs), especially in patients with risk factors for single-ventricle palliation (SVP) failure. When ventricular volume is inadequate for biventricular circulation, recruitment procedures may accommodate its growth. In this study, we review our uAVCD experience with biventricular conversion (BIVC) after prior SVP. Methods: This is a single-institution, retrospective cohort study of uAVCD patients who underwent BIVC after SVP, with staged recruitment (staged) or primary BIVC (direct) between 2003 to 2018. Mortality, unplanned reinterventions, imaging, and catheterization data were analyzed. Results: Sixty-five patients underwent BIVC from SVP (17 stage 1, 42 bidirectional Glenn, and 6 Fontan). Decision for conversion was based on poor SVP candidacy (n = 43) or 2 adequately sized ventricles (n = 22). Of the 65 patients, 20 patients underwent recruitment before conversion. The staged group had more severe ventricular hypoplasia than the direct group, reflected in prestaging end-diastolic volume z scores (–4.0 vs –2.6; P < .01), which significantly improved after recruitment (–4.0 to –1.8; P < .01). Median follow-up time was 1.0 years. Survival and recatheterizations were similar between both groups (hazard ratio, 0.9; 95% CI, 0.2-3.7; P = .95 and hazard ratio, 1.9; 95% CI, 0.9-4.1; P = .09), but more reoperations occurred with staged approach (hazard ratio, 3.1; 95% CI, 1.3-7.1; P = .01). Conclusions: Biventricular conversion from SVP is an alternative strategy to manage uAVCD, particularly when risk factors for SVP failure are present. Severe forms of uAVCDs can be converted with staged BIVC with acceptable mortality, albeit increased reinterventions, when primary BIVC is not possible.http://www.sciencedirect.com/science/article/pii/S266627362200417Xsingle ventricle palliationunbalanced atrioventricular canal defectbiventricular repair |
| spellingShingle | Nicholas A. Oh, MD Ilias P. Doulamis, MD Alvise Guariento, MD Breanna Piekarski, BSN, RN Gerald R. Marx, MD Pedro J. del Nido, MD Sitaram M. Emani, MD Staged ventricular recruitment and biventricular conversion following single-ventricle palliation in unbalanced atrioventricular canal defectsCentral MessagePerspective JTCVS Open single ventricle palliation unbalanced atrioventricular canal defect biventricular repair |
| title | Staged ventricular recruitment and biventricular conversion following single-ventricle palliation in unbalanced atrioventricular canal defectsCentral MessagePerspective |
| title_full | Staged ventricular recruitment and biventricular conversion following single-ventricle palliation in unbalanced atrioventricular canal defectsCentral MessagePerspective |
| title_fullStr | Staged ventricular recruitment and biventricular conversion following single-ventricle palliation in unbalanced atrioventricular canal defectsCentral MessagePerspective |
| title_full_unstemmed | Staged ventricular recruitment and biventricular conversion following single-ventricle palliation in unbalanced atrioventricular canal defectsCentral MessagePerspective |
| title_short | Staged ventricular recruitment and biventricular conversion following single-ventricle palliation in unbalanced atrioventricular canal defectsCentral MessagePerspective |
| title_sort | staged ventricular recruitment and biventricular conversion following single ventricle palliation in unbalanced atrioventricular canal defectscentral messageperspective |
| topic | single ventricle palliation unbalanced atrioventricular canal defect biventricular repair |
| url | http://www.sciencedirect.com/science/article/pii/S266627362200417X |
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