BIVENTRICULAR REPAIR IN NEONATES WITH HYPOPLASTIC LEFT-HEART COMPLEX

Background. Multiple obstructions in the left heart-aorta complex have been associated with poor survival. No consensus exists as to whether these patients will have a favorable outcome with biventricular repai r where most advocate a univentricular approach. Methods. Since late 1 988, all 11 neonates seen with hypoplastic left heart complex, which i ncludes aortic arch obstruction, underwent biventricular repair. All p atients had antegrade aortic now and no intrinsic aortic or mitral ste nosis. Elimination of the extracardiac afterload was achieved by exten sive ascending aorta and aortic arch reconstruction with a pulmonary h omograft patch. All intracardiac shunts were eliminated to fully prelo ad the left heart. The median age at first operation was 7 days and th e mean weight, 3.59 +/- 0.49 kg. The echocardiographic variables used to evaluate the left heart-aorta complex were reviewed, and the preope rative and postoperative measurements were compared. Results. There we re two early deaths. Four patients had six reoperations for left ventr icular outflow tract obstruction, 2 of whom have required prosthetic v alve replacement (1, aortic and mitral; 1, aortic), and 2 patients had three reoperations for recurrent coarctation. There was one late deat h at 3 years from pulmonary hypertension. Mean follow-up was 44 +/- 35 months. The 8 current survivors are all in New York Heart Association class I or II. The actuarial survival rate at 8 years is 63%, and the freedom from reoperation at 3 years is 25%. Conclusions. We have succ essfully achieved biventricular repair in most of the patients with hy poplastic left heart complex, a subset of patients with hypoplastic le ft heart syndrome. Some growth of the left ventricular structures was already observed at the time of hospital discharge. However, reoperati on, particularly for left ventricular outflow tract obstruction, appea rs likely. Increasing experience will more accurately define predictiv e criteria for the feasibility of biventricular repair. (Ann Thorac Su rg 1998;66:1350-7) (C) 1998 by The Society of Thoracic Surgeons