15. Ventricular Septation of the Double-Inlet Ventricle: Nearly Three Decades of Follow-Up
Presented During: Novel Strategies for Single Ventricle Management
New York Presbyterian / Columbia University Medical Center
New York, NY
United States - Contact Me
Integrated Cardiothoracic Surgery Resident, PGY-III
New York-Presbyterian / Columbia University Irving Medical Center
New York, NY
Saturday, May 6, 2023: 8:59 AM - 9:08 AM
9 Minutes
Los Angeles Convention Center
Room: 403B
Abstract
Objective
Septation of a functionally univentricular heart is a largely abandoned procedure due to poor historical outcomes. Recently, there has been renewed interest in ventricular septation as an alternative to Fontan palliation in select patients.
Methods
We conducted a retrospective review of all patients with double-inlet left or right ventricle (DILV or DIRV) from 1994-2015. Those with 2 adequate atrioventricular valves (AVV) and absence of severe outlet obstruction were candidates for septation. All procedures were performed using a 1- or 2-stage strategy. In the 1-stage repair, the ventricle is divided using a non-fenestrated polytetrafluoroethylene (PTFE) patch. The 2-stage repair initially involves placement of a fenestrated PTE patch and pulmonary artery (PA) banding, then patch closure of the fenestration and PA band removal 6-12 months later.
Results
Of 103 patients with double-inlet ventricle identified during the specified period, 10 (9.7%) patients underwent attempted ventricular septation as either a planned one- (3/10, 30%) or two-stage (7/10, 70%) approach during the study period; the remainder (93/103, 90.3%) underwent single-ventricle palliation. Diagnoses included DILV (9/10, 90%) and DIRV (1/10, 10%). The 3 patients who underwent 1-stage repair were aged 3.2, 20.2, and 62.6 months; median age for 2-stage repair was 7.4 months (IQR, 4.1-10.1) at the first stage and 21.4 months (IQR, 15.5-109.4) at the second stage. One patient required a pacemaker. Of the 7 patients planned for 2-stage repair, there was 1 in-hospital mortality due to fungal sepsis, 1 patient deferred complete septation (per family preference and asymptomatic due to native PS), and 1 patient underwent Fontan after partial septation due to an unrepairable left AVV. Of the 4 patients who underwent the second stage, there were no postoperative arrhythmias or early mortality. At median follow-up of 11.0 years (range, 2.1-25.6), none underwent transplant. One patient died 8 years after complete septation from leukemia. At latest follow-up, except for one patient with moderate right AVV regurgitation, all septated patients had normal function and no more than mild AVV stenosis or regurgitation. All are NYHA functional class I.
Conclusions
Ventricular septation of the double-inlet ventricle can be performed in select patients with excellent long-term outcomes. Reconsideration of this strategy is warranted in light of the known complications of Fontan circulation.
Septation of a functionally univentricular heart is a largely abandoned procedure due to poor historical outcomes. Recently, there has been renewed interest in ventricular septation as an alternative to Fontan palliation in select patients.
Methods
We conducted a retrospective review of all patients with double-inlet left or right ventricle (DILV or DIRV) from 1994-2015. Those with 2 adequate atrioventricular valves (AVV) and absence of severe outlet obstruction were candidates for septation. All procedures were performed using a 1- or 2-stage strategy. In the 1-stage repair, the ventricle is divided using a non-fenestrated polytetrafluoroethylene (PTFE) patch. The 2-stage repair initially involves placement of a fenestrated PTE patch and pulmonary artery (PA) banding, then patch closure of the fenestration and PA band removal 6-12 months later.
Results
Of 103 patients with double-inlet ventricle identified during the specified period, 10 (9.7%) patients underwent attempted ventricular septation as either a planned one- (3/10, 30%) or two-stage (7/10, 70%) approach during the study period; the remainder (93/103, 90.3%) underwent single-ventricle palliation. Diagnoses included DILV (9/10, 90%) and DIRV (1/10, 10%). The 3 patients who underwent 1-stage repair were aged 3.2, 20.2, and 62.6 months; median age for 2-stage repair was 7.4 months (IQR, 4.1-10.1) at the first stage and 21.4 months (IQR, 15.5-109.4) at the second stage. One patient required a pacemaker. Of the 7 patients planned for 2-stage repair, there was 1 in-hospital mortality due to fungal sepsis, 1 patient deferred complete septation (per family preference and asymptomatic due to native PS), and 1 patient underwent Fontan after partial septation due to an unrepairable left AVV. Of the 4 patients who underwent the second stage, there were no postoperative arrhythmias or early mortality. At median follow-up of 11.0 years (range, 2.1-25.6), none underwent transplant. One patient died 8 years after complete septation from leukemia. At latest follow-up, except for one patient with moderate right AVV regurgitation, all septated patients had normal function and no more than mild AVV stenosis or regurgitation. All are NYHA functional class I.
Conclusions
Ventricular septation of the double-inlet ventricle can be performed in select patients with excellent long-term outcomes. Reconsideration of this strategy is warranted in light of the known complications of Fontan circulation.
Presentation Duration
9 minute presentation