Key result
The late-era left ventricle rehabilitation strategy was associated with a significantly higher rate of biventricular repair compared to the early era (77% vs. 39%, p=0.004).
Why the study?
To assess the surgical outcomes of borderline hypoplastic left ventricle before and after introducing a left ventricle rehabilitation strategy.
Does a left ventricle rehabilitation strategy improve the rate of biventricular repair in patients with borderline hypoplastic left ventricle?
Cohort (n=58)
Does a left ventricle rehabilitation strategy improve the rate of biventricular repair in patients with borderline hypoplastic left ventricle?
Absolute Event Rate: 77% vs 39%
p-value: p=0.004
The introduction of a left ventricle rehabilitation strategy significantly increased the rate of successful biventricular repair in patients with borderline hypoplastic left ventricle without increasing mortality.
May support LV rehabilitation in borderline hypoplastic left ventricle; leaves open need for randomized confirmation of durability.
Objective: This study aims to assess the surgical outcome of borderline hypoplastic left ventricle before and after the induction of the left ventricle rehabilitation strategy. Methods: A retrospective review investigated patients with borderline hypoplastic left ventricle who underwent surgical intervention between 2012 and 2022. The patient cohort was stratified into two groups based on the initiation of left ventricle rehabilitation: an early-era group (E group, 2012–2017) and a late-era group (L group, 2018–2022). Left ventricle rehabilitation was defined as palliation combined with other procedures aimed at promoting left ventricular growth such as restriction of atrial septal defect, relief of inflow/outflow obstructive lesions, and resection of endocardial fibroelastosis. Results: A total of 58 patients were included. Primary diagnosis included 12 hypoplastic left heart syndromes, 11 critical aortic valve stenosis, and others. A total of 9 patients underwent left ventricle rehabilitation, 8 of whom underwent restriction of atrial septal defect. As for clinical outcomes, 9 of 23 patients achieved biventricular repair in the E group, whereas in the L group, 27 of 35 patients achieved biventricular repair (39% vs. 77%, p = 0.004). Mortality did not differ statistically between the two groups (log-rank test p = 0.182). As for the changes after left ventricle rehabilitation, left ventricular growth was observed in 8 of 9 patients. The left ventricular end-diastolic volume index (from 11.4 to 30.1 ml/m2, p = 0.017) and left ventricular apex-to-right ventricular apex ratio (from 86 to 106 %, p = 0.014) significantly increased after left ventricle rehabilitation. Conclusions: The introduction of the left ventricle rehabilitation strategy resulted in an increased proportion of patients achieving biventricular repair without a concomitant increase in mortality. Left ventricle rehabilitation was associated with enhanced left ventricular growth and the formation of a well-defined left ventricle apex. Our study underscores the significance of left ventricle rehabilitation strategies facilitating successful biventricular repair. The data suggest establishing restrictive atrial communication may be a key factor in promoting left ventricular growth.
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Osawa et al. (2024) conducted a cohort in Borderline hypoplastic left ventricle (n=58). Left ventricle rehabilitation strategy (late-era, 2018-2022) vs. Early-era group (2012-2017) was evaluated on Biventricular repair (p=0.004). The late-era left ventricle rehabilitation strategy was associated with a significantly higher rate of biventricular repair compared to the early era (77% vs. 39%, p=0.004).
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