Quality of Life in Children With Cyanotic Congenital Heart Disease With and Without Right Ventricular Failure After Corrective Surgery: A Prospective Comparative Study

BACKGROUND: Surgical progress has significantly facilitated survival in patients with cyanotic congenital heart disease (CCHD), but postoperative complications, particularly right ventricular failure (RVF), may substantially impair long-term quality of life (QOL). OBJECTIVE: This study aims to evaluate and compare the QOL of children with CCHD who developed right ventricular failure (RVF) after surgery with those who maintained preserved right ventricular function. METHODS: A prospective comparative study was conducted from January 2025 to March 2026 at the Sulaimani Children's Heart Hospital. A total of 400 children aged 3–13 years with corrective surgery for cyanotic CHD, with and without RVF, were included. Quality of life was evaluated using a structured questionnaire based on the Pediatric Quality of Life Inventory (PedsQL) Cardiac module and the Pediatric Cardiac Quality of Life Inventory (PCQLI), encompassing six domains. Data were analyzed using ANCOVA and two-way ANCOVA, adjusted for age, sex, and age at corrective surgery. Multivariate linear regression was additionally used to identify factors independently associated with QOL. P≤ 0.05 was considered statistically significant. RESULTS: After controlling for age, sex, and age at corrective surgery, children with RVF had significantly lower overall QoL scores than those without RVF (F = 135.35, p < 0.001, partial η² = 0.26). All QoL domains were significantly lower among children with RVF (all p < 0.001), with the largest effects observed for heart problems (partial η² = 0.27) and physical well-being (partial η² = 0.18), followed by general health (partial η² = 0.15). No significant RVF × age-group interaction was observed. In multivariable linear regression, child sex was independently associated with total QoL score (B = −2.88, p = 0.001), whereas child age (B = −0.12, p = 0.569) and age at corrective surgery (B = −0.25, p = 0.454) were not significantly associated with QoL. CONCLUSIONS: Right ventricular failure was independently associated with poorer quality of life in children with cyanotic congenital heart disease following corrective surgery. Children with RVF had significantly lower quality-of-life scores across all assessed domains, even after adjustment for age, sex, and age at corrective surgery. These findings highlight the importance of routine assessment of right ventricular function and integration of multidisciplinary supportive care during postoperative follow-up.