Hostname: page-component-669899f699-7xsfk Total loading time: 0 Render date: 2025-05-02T19:05:30.576Z Has data issue: false hasContentIssue false
  • English
  • Français

Surgical outcome of the borderline hypoplastic left ventricle: impact of the left ventricle rehabilitation strategy

Published online by Cambridge University Press:  14 October 2024

Haonan Cheng ,
Takuya Osawa Open the ORCID record for Takuya Osawa [Opens in a new window] ,
Jonas Palm Open the ORCID record for Jonas Palm [Opens in a new window] ,
Thibault Schaeffer ,
Paul Philipp Heinisch ,
Nicole Piber ,
Christoph Röhlig ,
Christian Meierhofer ,
Stanimir Georgiev  and
Alfred Hager
...Show all authors
Haonan Cheng
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
Takuya Osawa
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
Jonas Palm
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
Thibault Schaeffer
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
Paul Philipp Heinisch
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
Nicole Piber
Affiliation:
Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
Christoph Röhlig
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
Christian Meierhofer
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
Stanimir Georgiev
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
Alfred Hager
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
Peter Ewert
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
Jürgen Hörer
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
Masamichi Ono*
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
*
Corresponding author: Masamichi Ono; Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Keywords

Borderline hypoplastic left ventricleleft ventricle rehabilitationleft ventricle growthbiventricular repair
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 12 , December 2024 , pp. 2626 - 2635
Check for updates
Copyright
© German Heart Center Munich, 2024. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Haonan Cheng and Takuya Osawa contributed equally to this work.

References

Emani, SM, Bacha, EA, McElhinney, DB et al. Primary left ventricular rehabilitation is effective in maintaining two-ventricle physiology in the borderline left heart. J Thorac Cardiovasc Surg 2009; 138: 1276–1282.CrossRefGoogle ScholarPubMed
Akintürk, H, Yörüker, U, Müller, M et al. Hypoplastic left ventricle: left ventricular recruitment with hybrid approach. World J Pediatr Congenit Heart Surg 2022; 13: 637–644.CrossRefGoogle ScholarPubMed
Haller, C, Honjo, O, Caldarone, CA et al. Growing the borderline hypoplastic left ventricle: hybrid approach. Oper Tech Thorac Cardiovasc Surg 2016; 21: 124–138.CrossRefGoogle Scholar
Cantinotti, M, Marchese, P, Giordano, R, et al. Echocardiographic scores for biventricular repair risk prediction of congenital heart disease with borderline left ventricle: a review. Heart Fail Rev 2023; 28: 63–76.CrossRefGoogle ScholarPubMed
Serraf, A, Piot, JD, Bonnet, N et al. Biventricular repair approach in ducto-dependent neonates with hypoplastic but morphologically normal left ventricle. J Am Coll Cardiol 1999; 33: 827–834.CrossRefGoogle ScholarPubMed
Kalish, BT, Banka, P, Lafranchi, T et al. Biventricular conversion after single ventricle palliation in patients with small left heart structures: short-term outcomes. Ann Thorac Surg 2013; 96: 1406–1412.CrossRefGoogle ScholarPubMed
Herrin, MA, Zurakowski, D, Baird, CW et al. Hemodynamic parameters predict adverse outcomes following biventricular conversion with single-ventricle palliation takedown. J Thorac Cardiovasc Surg 2017; 154: 572–582.CrossRefGoogle ScholarPubMed
Rhodes, LA, Colan, SD, Perry, SB et al. Predictors of survival in neonates with critical aortic stenosis. Circulation 1991; 84: 2325–2335.CrossRefGoogle ScholarPubMed
Hickey, EJ, Caldarone, CA, Blackstone, EH et al. Critical left ventricular outflow tract obstruction: the disproportionate impact of biventricular repair in borderline cases. J Thorac Cardiovasc Surg 2007; 134: 1429–1436.CrossRefGoogle ScholarPubMed
Colan, SD, McElhinney, DB, Crawford, EC et al. Validation and re-evaluation of a discriminant model predicting anatomic suitability for biventricular repair in neonates with aortic stenosis. J Am Coll Cardiol 2006; 47: 1858–1865.CrossRefGoogle ScholarPubMed
Emani, SM, McElhinney, DB, Tworetzky, W et al. Staged left ventricular recruitment after single-ventricle palliation in patients with borderline left heart hypoplasia. J Am Coll Cardiol 2012; 60: 1966–1974.CrossRefGoogle ScholarPubMed
Oladunjoye, OO, Piekarski, B, Banka, P et al. Staged ventricular recruitment in patients with borderline ventricles and large ventricular septal defects. J Thorac Cardiovasc Surg 2018; 156: 254–264.CrossRefGoogle ScholarPubMed
Pettersen, MD, Du, W, Skeens, ME et al. Regression equations for calculation of Z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr 2008; 21: 922–934.CrossRefGoogle Scholar
Haycock, GB, Schwartz, GJ, Wisotsky, DH. Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults. J Pediatr 1978; 93: 62–66.CrossRefGoogle ScholarPubMed
Lang, RM, Bierig, M, Devereux, RB et al. Recommendations for chamber quantification: a report from the American society of echocardiography’s guidelines and standards committee and the chamber quantification writing group. J Am Soc Echocardiogr 2005; 18: 1440–1463.CrossRefGoogle ScholarPubMed
Corno, AF. Review borderline left ventricle. Eur J Cardiothorac Surg 2005; 27: 67–73.CrossRefGoogle ScholarPubMed
Tchervenkov, CI, Tahta, SA, Jutras, LC et al. Biventricular repair in neonates with hypoplastic left heart complex. Ann Thorac Surg 1998; 66: 1350–1357.CrossRefGoogle ScholarPubMed
Han, RK, Gurofsky, RC, Lee, KJ et al. Outcome and growth potential of left heart structures after neonatal intervention for aortic valve stenosis. J Am Coll Cardiol 2007; 50: 2406–2414.CrossRefGoogle ScholarPubMed
McElhinney, DB, Lock, JE, Keane, JF et al. Left heart growth, function, and reintervention after balloon aortic valvuloplasty for neonatal aortic stenosis. Circulation 2005; 111: 451–458.CrossRefGoogle ScholarPubMed
Lofland, GK, McCrindle, BW, Williams, WG et al. Critical aortic stenosis in the neonate: a multi-institutional study of management, outcomes, and risk factors. J Thorac Cardiovasc Surg 2001; 121: 10–27.CrossRefGoogle ScholarPubMed
Tuo, G, Khambadkone, S, Tann, O et al. Obstructive left heart disease in neonates with a “Borderline” left ventricle: diagnostic challenges to choosing the best outcome. Pediatr Cardiol 2013; 34: 1567–1576.CrossRefGoogle ScholarPubMed
Sojak, V, Bokenkamp, R, Kuipers, I et al. Left heart growth and biventricular repair after hybrid palliation. Interact Cardiovasc Thorac Surg 2021; 32: 792–799.CrossRefGoogle ScholarPubMed
Petit, CJ. Staged single-ventricle palliation in 2011: outcomes and expectations. Congenit Heart Dis 2011; 6: 406–416.CrossRefGoogle ScholarPubMed
Supplementary material: File

Cheng et al. supplementary material 1

Cheng et al. supplementary material
Download Cheng et al. supplementary material 1(File)
File 1.3 MB
Supplementary material: File

Cheng et al. supplementary material 2

Cheng et al. supplementary material
Download Cheng et al. supplementary material 2(File)
File 21.1 KB
Supplementary material: File

Cheng et al. supplementary material 3

Cheng et al. supplementary material
Download Cheng et al. supplementary material 3(File)
File 656.6 KB