Key result
Biventricular repair achieves ~75% 5-year transplant-free survival in borderline LV despite frequent reinterventions.
Why the study?
The decision to perform BVR in neonates and infants with LVOTO and borderline left ventricle is widely debated, with limited data on long-term outcomes.
Does biventricular repair provide favorable long-term outcomes in neonates and infants with left heart obstruction and borderline left ventricle?
Does biventricular repair provide favorable long-term outcomes in neonates and infants with left heart obstruction and borderline left ventricle?
Biventricular repair in neonates and infants with borderline left ventricle and left ventricular outflow tract obstruction offers acceptable long-term survival, but is associated with a high lifelong burden of reinterventions.
May support biventricular repair in select borderline left ventricle cases despite reintervention burden; extends pooled evidence and calls for reintervention mitigation trials.
BACKGROUND: The decision to perform biventricular repair (BVR) in neonates and infants presenting with either single or multiple left ventricle outflow obstructions (LVOTOs) and a borderline left ventricle (BLV) is subject to extensive discussion, and limited information is known regarding the long-term outcomes. As a result, the objective of this study is to critically assess and summarize the available data regarding the prognosis of neonates and infants with LVOTO and BLV who underwent BVR. METHODS: In February 2023, we conducted a review study with three different medical search engines (the National Library of Medicine, Science Direct, and Cochrane Library) for Medical Subject Headings and free text terms including "congenital heart disease", "outcome", and "borderline left ventricle". The search was refined by adding keywords for "Shone's complex", "complex LVOT obstruction", "hypoplastic left heart syndrome/complex", and "critical aortic stenosis". RESULTS: Out of a total of 51 studies, 15 studies were included in the final analysis. The authors utilized heterogeneous definitions to characterize BLV, resulting in considerable variation in inclusion criteria among studies. Three distinct categories of studies were identified, encompassing those specifically designed to evaluate BLV, those focused on Shone's complex, and finally those on aortic stenosis. Despite the challenges associated with comparing data originating from slightly different cardiac defects and from different eras, our results indicate a favorable survival rate and clinical outcome following BVR. However, the incidence of reintervention remains high, and concerns persist regarding residual pulmonary hypertension, which has been inadequately investigated. CONCLUSIONS: The available data concerning neonates and infants with LVOTO and BLV who undergo BVR are inadequate and fragmented. Consequently, large-scale studies are necessary to fully ascertain the long-term outcome of these complex defects.
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Cantinotti et al. (2024) conducted a review in Left heart obstruction and borderline left ventricle. Biventricular repair was evaluated on Long-term survival and freedom from reintervention. Biventricular repair in neonates and infants with borderline left ventricle yields favorable 5-year transplant-free survival rates ranging from 70% to 82%, but is associated with a high burden of reinterventions.
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