title: Predictors of survival after single-ventricle palliation: the impact of right ventricular dominance.
abstract: OBJECTIVE
  This study examined survival after surgical palliation in children with single-ventricle physiology.
  
  
  BACKGROUND
  Contemporary surgical outcomes for the entire population of newborns undergoing single-ventricle palliation are unclear.
  
  
  METHODS
  In a single-center review of 499 consecutive patients undergoing univentricular palliation from 1990 to 2008, predictors of mortality were determined using multivariate risk analysis, stratified for each post-operative stay and interim states.
  
  
  RESULTS
  After 2000, the population comprised more patients with dominant right ventricle (66% vs. 36%) and hypoplastic left heart syndrome (HLHS) (47% vs. 13%). Median age at bidirectional cavopulmonary shunt (BCPS) decreased from 15 months (10 to 22 months) before 2000 to 4 months (3.3 to 9 months) thereafter. Survival rates at 1, 5, and 10 years were, respectively, 82% (95% confidence interval [CI]: 79% to 85%), 74% (95% CI: 70% to 78%), and 71% (95% CI: 67% to 75%). Throughout the study, atrioventricular valve regurgitation (hazard ratio [HR]: 1.8; p = 0.008), not having transposition (HR: 2.0; p = 0.013), and heterotaxia (HR: 2.0; p = 0.026) were predictors of mortality. The most potent risk factor was right ventricular (RV) dominance (HR: 2.2; p = 0.001) because of its impact before BCPS. HR for death in patients with RV dominance went from 2.8 (95% CI: 1.4 to 5.7; p = 0.005) before BCPS to 1.0 (95% CI: 0.5 to 2.1; p = 0.98) thereafter. Survival of patients with RV dominance, adjusted for the risk factors noted here, improved over the study period (p = 0.001).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiac Surgery, Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Flemington Road, Parkville, Melbourne, Australia. yves.dudekem@rch.org.au
authors.forename: Yves
authors.initials: Y
authors.lastname: d'Udekem
authors.forename: Mary Y
authors.initials: MY
authors.lastname: Xu
authors.forename: John C
authors.initials: JC
authors.lastname: Galati
authors.forename: Siming
authors.initials: S
authors.lastname: Lu
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Iyengar
authors.forename: Igor E
authors.initials: IE
authors.lastname: Konstantinov
authors.forename: Gavin R
authors.initials: GR
authors.lastname: Wheaton
authors.forename: James M
authors.initials: JM
authors.lastname: Ramsay
authors.forename: Leeanne E
authors.initials: LE
authors.lastname: Grigg
authors.forename: Johnny
authors.initials: J
authors.lastname: Millar
authors.forename: Michael M
authors.initials: MM
authors.lastname: Cheung
authors.forename: Christian P
authors.initials: CP
authors.lastname: Brizard
mesh_terms: D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010166:Palliative Care; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis