Key result
Staged left ventricular recruitment increased left heart dimensions over time compared to traditional single-ventricle palliation, with mortality occurring in 11.8% vs 20.6% of patients.
Why the study?
The study evaluated a novel management strategy to rehabilitate the left heart and potentially achieve biventricular conversion in patients with left heart hypoplasia and borderline left ventricle after single-ventricle palliation.
Cohort (n=68)
Absolute Event Rate: 11.8% vs 20.6%
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Children have an enormous growth and healing potential. We realized that rather than give up on the left ventricle and commit a child to single ventricle circulation for life, we could leverage that growth potential in a staged approach that would promote growth in the left ventricle and gradually recruit it back into operation.”
“The Boston group, as always, are to be credited for examining provocative strategies to enhance congenital cardiac care. Indeed, for those who are poor Fontan candidates, the option of a salvage high-risk 2-ventricle conversion may be the best of bad choices.”
“We believe the SLVR strategy could revolutionise the paediatric cardiology field's approach to treatment of HLHS.”
Randomized trial demonstrates improved hemodynamic outcomes in patients with borderline left heart hypoplasia after staged ventricular recruitment.
OBJECTIVES The goal of this study was to review results of a novel management strategy intended to rehabilitate the left heart (LH) in patients with LH hypoplasia who have undergone single-ventricle palliation (SVP). BACKGROUND Management of patients with hypoplastic LH syndrome and borderline left ventricle (LV) involves 2 options: SVP or biventricular repair. We hypothesized that staged LV recruitment and biventricular conversion may be achieved after SVP by using a strategy consisting of relief of inflow and outflow tract obstructions, resection of endocardial fibroelastosis, and promotion of flow through the LV. METHODS Patients with hypoplastic LH and borderline LV who underwent traditional SVP (n = 34) or staged LV recruitment (n = 34) between 1995 and 2010 were retrospectively analyzed and compared with a control SVP group. RESULTS Mean initial z-scores for LH structures before stage 1 SVP were not significantly different between groups. Mortality occurred in 4 of 34 patients after LV recruitment and in 7 of 34 after traditional SVP. LH dimension z-scores increased significantly over time after LV recruitment, whereas they declined after traditional SVP, with significant interaction between stage of palliation and treatment group. Restriction of the atrial septum (conducted in 19 of 34 patients) was the only predictor of increase in left ventricular end-diastolic volume (p < 0.001). Native biventricular circulation was achieved in 12 patients after staged LV recruitment; all of these patients had restriction at the atrial septum. CONCLUSIONS In these patients with borderline LH disease who underwent SVP, it is possible to increase LH dimensions by using an LV recruitment strategy. In a subset of patients, this strategy allowed establishment of biventricular circulation.
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Emani et al. (2012) conducted a cohort in Hypoplastic left heart syndrome and borderline left ventricle (n=68). Staged left ventricular recruitment vs. Traditional single-ventricle palliation was evaluated on Mortality. Staged left ventricular recruitment increased left heart dimensions over time compared to traditional single-ventricle palliation, with mortality occurring in 11.8% vs 20.6% of patients.
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