IS A HIGH-RISK BIVENTRICULAR REPAIR ALWAYS PREFERABLE TO CONVERSION TO A SINGLE VENTRICLE REPAIR

Objectives: The aim of this report is to examine the short-and interme diate-term outcome of a complex biventricular repair compared with a s ingle ventricle repair in patients with two functional ventricles, Pat ient population: Since 1986, 34 patients with atrioventricular concord ance or discordance, ventriculoarterial discordance, ventricular septa l defect, and pulmonary stenosis or atresia have undergone biventricul ar repair (group I), Another group of 16 patients (group II) with the same diagnoses have undergone a single ventricle repair consisting of a total cavopulmonary connection because of either a straddling atriov entricular valve (11 patients) or an uncommitted ventricular septal de fect (5 patients), Results: The mean length of follow-up was 3.9 years in group I and 3.0 years in group II, Freedom from reoperation at 7 y ears was 45.5% in group I and 100% in group II (p = 0.014). The actuar ial estimate of survival at 7 years was 68.0% in group I and 93.8% in group II (p = 0.048), Conclusion: Short- and intermediate-term morbidi ty and mortality were greater in patients undergoing a biventricular r epair than in a similar group of patients undergoing total cavopulmona ry connection, It is unknown whether the long-term results of a total cavopulmonary connection in patients with two ventricles are as good a s those obtained with a biventricular approach, However, there may be situations in which the short- and intermediate-term risks of a comple x biventricular repair may outweigh the long-term disadvantages of a s ingle ventricle approach.