Midterm Follow-Up After Biventricular Repair of the Hypoplastic Left Heart Complex.
BACKGROUND
In neonates with hypoplastic left heart complex (HLHC), biventricular repair is considered superior to univentricular repair. The Z-scores of the mitral and the aortic valve annulus are primary factors for the choice of repair. Predictive cutoff values for the feasibility and optimal outcome of biventricular repair are unknown. This study assesses the growth of left side heart structures and the midterm outcome after biventricular repair with an interatrial fenestration in our HLHC population.


METHODS
Retrospective study of 19 HLHC patients who underwent biventricular repair in a single tertiary referral center between 2004 and 2013. The cardiac dimensions (mitral and aortic valve annulus, left ventricle inlet length, left ventricular internal diastolic dimension) were measured before and at 6, 12, 24, and 48 months after biventricular repair.


RESULTS
The follow-up ranged from 2 to 98 months. There was no early mortality, and the midterm survival rate was 95%. One patient died of a noncardiac- and nonintervention-related cause. Seven patients (37%) required a total of 8 reinterventions because of recurring or residual obstructive lesions. After biventricular repair, the left cardiac structures grew significantly.


CONCLUSIONS
Neonatal biventricular repair is successful and safe in HLHC patients, even with preoperative mitral and aortic valve annulus Z-scores of -4.5 and -5.5, respectively. Residual or restenosis required reintervention in 37% of our HLHC population, but was not significantly correlated with the magnitude of the preoperative Z-scores. Within the first 6 months of follow-up, the Z-scores almost normalized.
Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, Netherlands. Electronic address: freund.matthias@klinikum-oldenburg.de.
Jan Erik
JE
Freund
Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, Netherlands.
Martijn H T
MH
den Dekker
Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, Netherlands.
A Christian
AC
Blank
Department of Pediatric Cardiac Surgery, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, Netherlands.
Felix
F
Haas
Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, Netherlands.
Matthias W
MW
Freund
D006348:Cardiac Surgical Procedures / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011184:Postoperative Period; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors