Perioperative Outcomes of Noncardiac Surgical and Interventional Procedures in Adults with Single-Ventricle Physiology: A Retrospective Cohort Study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Single-ventricle physiology (n=67). Intervention: Noncardiac surgical and interventional procedures requiring anesthesia or sedation. Primary outcome: Perioperative complications (intraoperative and postoperative adverse events requiring intervention or associated with instability) across 114 procedures, and all-cause mortality at 24 h, 30 days, and 1 year.

Q: What does this research mean for the field?

Adults with single-ventricle physiology undergoing noncardiac surgical and interventional procedures exhibit acceptable perioperative safety with a 6.1% complication rate and 2.9% 30-day mortality, with adverse outcomes concentrated in patients with earlier-stage palliation, advanced functional limitation, or multiple comorbidities. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Montserrat Ribas-Ball; Laura González; Ekaterine Popova; Clara Bordes; Patricia Galan; Laura Villarino; Alfons Gómez; Maria Josefa Azpiroz; M. De Miguel; Laura Dos; Miriam de Nadal

doi:10.3390/jcm15134921

June 24, 2026Journal of Clinical MedicineOpen Access

Perioperative Outcomes of Noncardiac Surgical and Interventional Procedures in Adults with Single-Ventricle Physiology: A Retrospective Cohort Study

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Key result

Noncardiac procedures in adults with single-ventricle physiology carry a ~6% complication rate.

n=67

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Why the study?

Adults with single-ventricle physiology have complex cardiovascular conditions and increasing need for noncardiac procedures, but perioperative outcomes remain poorly characterized.

What are the rates of perioperative complications and all-cause mortality in adults with single-ventricle physiology undergoing noncardiac surgical and interventional procedures requiring anesthesia or sedation?

Key Points

To characterize perioperative management, complications, and mortality in adults with single-ventricle physiology undergoing noncardiac surgical and interventional procedures.
Conducted a retrospective cohort study of all adult patients (≥18 years, N=67) with single-ventricle physiology undergoing 114 noncardiac procedures requiring anesthesia or sedation at a tertiary university hospital between 1 January 1995 and 30 November 2023.
Assessed demographic data, underlying congenital heart disease, functional status, comorbidities, procedural urgency, surgical risk categories, and anesthetic techniques.
Tracked complications requiring intervention or causing instability, alongside patient-level all-cause mortality evaluated at 24 hours, 30 days, and one year.
The overall complication rate across 114 procedures was 6.1%, comprising 2.6% intraoperative and 3.5% postoperative adverse events.
Patient-level all-cause mortality was 1.5% (1/67) at 24 hours, 2.9% (2/67) at 30 days, and 5.9% (4/67) at one year.
Most procedures were elective (78.9%) and performed under sedation with or without local anesthesia (67.5%), with adverse events occurring predominantly in patients with earlier-stage palliation, higher NYHA functional class, or multiple comorbidities.

Study Design

Type

Cohort (n=67)

Multicenter

No

Structured PICO

What are the rates of perioperative complications and all-cause mortality in adults with single-ventricle physiology undergoing noncardiac surgical and interventional procedures requiring anesthesia or sedation?

P

Population

67 adults (mean age 32.3 years, 52.2% female) with single-ventricle physiology undergoing 114 noncardiac surgical or interventional procedures requiring anesthesia or sedation, followed for up to 1 year.

E

Exposure

Noncardiac surgical and interventional procedures (78.9% elective, 21.1% urgent; 40.4% cardiology-related such as catheter ablation and cardioversion, 19.3% digestive endoscopic, 11.4% angiological, 11.4% gynecological, 7% general surgical) performed under anesthesia or sedation (67.5% sedation with or without local anesthesia typically using IV midazolam 0.02–0.05 mg/kg, propofol 0.5–1 mg/kg, and/or remifentanil 0.025–0.1 μg/kg/min; 27.2% general anesthesia; 5.3% other anesthetic techniques).

O

Outcome

Perioperative complications (defined as intraoperative or postoperative adverse events requiring intervention or associated with hemodynamic, respiratory, or cardiovascular instability) and patient-level all-cause mortality at 24 hours, 30 days, and 1 year.hard clinical

In adults with single-ventricle physiology, predominantly elective and minimally invasive noncardiac procedures managed at a specialized center carry an acceptable perioperative risk (6.1% overall complications, 2.9% 30-day mortality), with adverse events concentrated in patients with incomplete palliation or advanced functional limitation.

Limitations

Retrospective, single-center design with potential selection and information bias
Inconsistent availability of detailed intraoperative hemodynamic data and standardized perioperative management variables
Small sample size and low number of adverse events precluded comparative analyses, regression models, and clustering adjustments
Heterogeneity of congenital diagnoses and stages of palliation complicates risk stratification
Most procedures were minor, elective, and performed under sedation, limiting generalizability to major or highly invasive surgeries
Observations were not fully independent as some patients underwent multiple procedures
Extended inclusion period (1995-2023) introduced temporal heterogeneity in perioperative management and patient selection
Retrospective, single-center design presenting potential selection and information bias
Detailed intraoperative hemodynamic data and standardized perioperative management variables were not consistently or fully available across all cases
Small sample size and low number of events precluded meaningful comparative analyses between groups and clustering-adjusted models
Observations were not fully independent because some patients underwent multiple procedures, introducing within-subject correlation
Extended inclusion period (1995–2023) may have introduced temporal heterogeneity in perioperative management and patient selection

Implication

Supports perioperative counseling in single-ventricle adults; leaves open prospective validation of risk predictors.

Abstract

Background/Objectives: Adults with single-ventricle physiology (SVP) represent a growing population with complex cardiovascular conditions and an increasing need for noncardiac surgical and interventional procedures. However, perioperative outcomes in this group remain poorly characterized. This study aimed to provide a descriptive characteristic of perioperative management, complications and mortality in adults with SVP undergoing noncardiac surgical and interventional procedures. Methods: We conducted a retrospective cohort study including all adult patients (≥18 years) with SVP who underwent noncardiac surgical and interventional procedures requiring anesthesia or sedation at a tertiary university hospital between 1 January 1995 and 30 November 2023. Demographic data, comorbidities, type of procedure and anesthetic technique were collected. Complications were defined as intraoperative or postoperative adverse events requiring intervention or associated with hemodynamic, respiratory, or cardiovascular instability. Primary outcomes were perioperative complications and all-cause mortality at 24 h, 30 days, and one year, with mortality reported at the patient level. Results: A total of 114 procedures were performed in 67 patients (mean age 32.3 ± 10.8 years). Most procedures were elective (78.9%) and minimally invasive, frequently performed under sedation, with or without local anesthesia (67.5%). Common comorbidities included arrhythmias (46.3%), liver disease (49.3%), and heart failure (17.9%). The overall complication rate was 6.1% (2.6% intraoperative, 3.5% postoperative). Mortality was 1.5% in 24 h, 2.9% in 30 days and 5.9% at one year. Most clinically relevant adverse events occurred in patients with earlier-stage palliation, advanced functional limitation or multiple comorbidities. Conclusions: Perioperative outcomes in adults with SVP undergoing noncardiac surgical and interventional procedures were acceptable when procedures were elective and managed in specialized settings. Risk remains heterogeneous and appears to be influenced by physiological status and stage of palliation.

Discussion

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Cite This Study

Ribas-Ball et al. (2026) conducted a cohort in Single-ventricle physiology (n=67). Noncardiac surgical and interventional procedures requiring anesthesia or sedation was evaluated on Perioperative complications (intraoperative and postoperative adverse events requiring intervention or associated with instability) across 114 procedures, and all-cause mortality at 24 h, 30 days, and 1 year. Noncardiac surgical and interventional procedures in adults with single-ventricle physiology resulted in a 6.1% overall perioperative complication rate and 2.9% 30-day mortality.

synapsesocial.com/papers/6a3f69caaea7db3c195408b3 https://doi.org/10.3390/jcm15134921

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Perioperative Outcomes of Noncardiac Surgical and Interventional Procedures in Adults with Single-Ventricle Physiology: A Retrospective Cohort Study

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Perioperative Outcomes of Noncardiac Surgical and Interventional Procedures in Adults with Single-Ventricle Physiology: A Retrospective Cohort Study

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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