Abstract
Background: Although Fontan palliation seems to be inevitable for many patients with complex congenital heart defects (CHDs), candidates with appropriate conditions could be selected for biventricular conversion. We aimed to summarize our single-center experience in patient selection, surgical strategies, and early outcomes in biventricular conversion for the complex CHD.Methods: From April 2017 to June 2021, we reviewed 23 cases with complex CHD who underwent biventricular conversion. Patients were divided into two groups according to the development of the ventricles: balanced ventricular group (15 cases) and imbalanced ventricular group (8 cases). Early and short-term outcomes during the 30.2 months (range, 4.2–49.8 months) follow-up period were compared.Results: The overall mortality rate was 4.3% with one death case. In the balanced ventricular group, 6 cases received 3D printing for pre-operational evaluation. One case died because of heart failure in the early postoperative period. One case received reoperation due to the obstruction of the superior vena cava. In the imbalanced ventricular group, the mean left ventricular end-diastolic volume was (33.6 ± 2.1) ml/m2, the mean left ventricular end-diastolic pressure was 9.1 ± 1.9 mmHg, and 4 cases received 3D printing. No death occurred while one case implanted a pacemaker due to a third-degree atrioventricular block. The pre-operational evaluation and surgery simulation with a 3D printing model helped to reduce bypass time in the balanced group (p < 0.05), and reduced both bypass and aorta clamp time in the imbalanced group (p < 0.05). All patients presented great cardiac function in the follow-up period.Conclusion: Comprehensive evaluation, especially 3D printing technique, was conducive to finding the appropriate cases for biventricular conversion and significantly reduced surgery time. Biventricular conversion in selected patients led to promising clinical outcomes, albeit unverified long-term results.
Highlights
The intricate variation of intracardiac anomalies and imbalanced ventricular development largely restrain the surgical choices for complex congenital heart defects (CHDs)
When the decision of whether to perform biventricular conversion was hard to make due to limited information provided by traditional flat images, we employed a 3D printing heart model as an adjunction
Six patients in the balanced ventricular group and 4 patients in the imbalanced ventricular group received 3D printing before the operation, which was used to determine the key factors of biventricular conversion
Summary
The intricate variation of intracardiac anomalies and imbalanced ventricular development largely restrain the surgical choices for complex congenital heart defects (CHDs). A large number of patients with single ventricular circulation experience poor life quality due to various progressive and burdensome complications accumulated with time, which remains its inherent problem [5,6,7,8]. We described and summarized our single-center surgical strategies of biventricular conversion from Fontan palliation for patients with complex CHDs, and we hypothesized and depicted that the 3D printing technique was helpful in pre-operational evaluation. Fontan palliation seems to be inevitable for many patients with complex congenital heart defects (CHDs), candidates with appropriate conditions could be selected for biventricular conversion. We aimed to summarize our single-center experience in patient selection, surgical strategies, and early outcomes in biventricular conversion for the complex CHD
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