Abstract 16788: Anatomical Repair Can Be Facilitated by Three-Dimensional Cardiac Printing in the Patients With Double Outlet Right Ventricle

Abstract

Introduction: Determination of optimal strategy between single ventricle palliation (SVP) versus left ventricular recruitment (LVR) as a systemic ventricle is challenging in the patients with complicated double outlet right ventricle (DORV). We sought that three-dimensionally printed cardiac models (3DM) may enables the surgeons to make an intuitive preoperative decision potentially in favor of LVR. Hypothesis: Use of 3DM can extend the candidates for LVR and improve surgical outcomes. Methods: We retrospectively reviewed the patients with DORV from Jan 2008 to Jun 2018 in single center. The patients with discordant atrioventricular (AV) connection, complete AV septal defect and atresia of AV valves were excluded. The patients without at least one of LVR precluding factors such as left or right ventricular hypoplasia, mitral valve (MV) or tricuspid valve (TV) straddling, TV interposition in potential baffle course, huge ventricular septal defect (VSD), multiple VSDs and remote VSD were excluded. All patients were divided in SVP or LVR group except two patients without clear determination of strategy. Finally, 100 patients were enrolled and since 2016, 3DM was made in the patients with LVR precluding anatomy for better consensus formation whether LVR could be feasible in 26 patients. Risk factor analysis was done for SVP and adverse outcome. Results: Thirty-five patients enrolled as SVP strategy (Fontan operation in 14, Kawashima operation in 1, interstage mortality in 12, follow-up loss in 3 and waiting scheduled operation in 5) and 65 patients enrolled as LVR strategy (complete anatomical correction in 50, one and half ventricle repair in 6 and waiting scheduled operation in 9). In multivariate analysis, LV hypoplasia ( P =0.003) and MV straddling ( P =0.015) were significant LVR precluding factors and the use of 3DM was a favorable factor for LVR ( P =0.039, OR=0.212). Risk factor for mortality were LV outflow tract obstruction ( P =0.006) and LV hypoplasia ( P =0.043). The use of 3DM did not reach statistical significance on mortality ( P =0.132). Conclusions: In DORV patients, LVR can be precluded especially with LV hypoplasia and MV straddling however, LVR can be facilitated by direct-vision driven preoperative decision about complicated features with 3DM.