Key result
Term gestation (≥37 weeks) was associated with an 86% lower risk of short-term adverse outcomes compared to preterm birth (OR 0.14) in neonates with pulmonary atresia with intact ventricular septum undergoing biventricular repair.
Why the study?
Outcome variability persists after biventricular repair for PA/IVS despite adequate right ventricular development, and the specific impact of gestational age on short-term outcomes remains inadequately characterized.
Does term gestational age improve short-term outcomes in neonates with pulmonary atresia with intact ventricular septum undergoing biventricular repair?
Cohort (n=97)
No
Does term gestational age improve short-term outcomes in neonates with pulmonary atresia with intact ventricular septum undergoing biventricular repair?
Odds Ratio: 0.14 (95% CI 0.04–0.46)
Absolute Event Rate: 19.7% vs 57.1%
p-value: p=0.001
Extending gestation beyond 37.6 weeks significantly improves short-term outcomes in neonates with PA/IVS undergoing biventricular repair, providing evidence for perinatal management.
Background Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare critical congenital heart defect. Although biventricular repair is reserved for those with adequate right ventricular development, significant outcome variability persists even among anatomically similar patients, implicating non-structural determinants of surgical recovery. Gestational age has been recognized as a prognostic factor in various congenital heart diseases, yet its specific impact on short-term outcomes after biventricular repair for PA/IVS remains inadequately characterized. Methods This retrospective cohort study enrolled 97 consecutive pediatric patients with PA/IVS who underwent biventricular repair at a single tertiary referral center from 1999 to 2024. Participants were categorized as preterm or term according to standard gestational age criteria. Results The cohort comprised 21 preterm infants and 76 term infants. Multivariable analysis showed each additional gestational week reduced adverse outcome risk by 45% (OR 0.55, 95% CI 0.41–0.75). Term infants demonstrated significantly lower risk vs. preterm infants (OR 0.14, 95% CI 0.04–0.46). Restricted cubic spline regression revealed a nonlinear threshold effect ( P -nonlinear=0.047) with an inflection point at 37.6 weeks (95% CI 36.6–38.7). Beyond this threshold infants had a 92% lower risk compared with those under 37.6 weeks (OR 0.08, 95% CI 0.02–0.42). Conclusions This study establishes a gestational age threshold effect for short-term outcomes in PA/IVS patients undergoing biventricular repair. Extending gestation beyond 37.6 weeks significantly improves short-term outcomes in PA/IVS patients undergoing biventricular repair, providing crucial evidence-based guidance for perinatal management.
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Chen et al. (2026) conducted a cohort in Pulmonary atresia with intact ventricular septum (PA/IVS) (n=97). Term gestation (≥37 weeks) vs. Preterm gestation (<37 weeks) was evaluated on Short-term adverse outcomes (composite of prolonged hospital/ICU stay or major adverse event) (OR 0.14, 95% CI 0.04-0.46, p=0.001). Term gestation (≥37 weeks) was associated with an 86% lower risk of short-term adverse outcomes compared to preterm birth (OR 0.14) in neonates with pulmonary atresia with intact ventricular septum undergoing biventricular repair.
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