One-and-a-Half Ventricle Repair in Adult Patients: A Word of Caution

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Abstract

Objectives:

The “one-and-a-half ventricle repair” (1.5 VR) is applied to several congenital heart diseases with hypoplastic right ventricle (RV), with good functional and clinical results in infants and children, but feasibility in adult population is being explored.

Materials and Methods:

This is a retrospective analysis of medical records of all adult patients undergoing 1 + 1/5 VR between 2000 and 2012.

Results:

Five patients (M/F = 4/1, mean age of 42.3 years, range 29–66.8) underwent 1 + 1/5 VR. Underlying diagnoses were Ebstein's anomaly (EA) in three, hypoplastic RV and tricuspid valve (TV) in two. Mean TV annulus Z-score was −3.0; mean pulmonary vascular resistance was 1.6 WU/m2. Eleven associated procedures were performed simultaneously to 1.5 VR. There were no operative deaths. All patients were discharged home alive and in good clinical condition on anticoagulation regimen. At a mean follow-up of 8.6 ± 5.2 years, there was one cerebral stroke-related death; two patients experienced major complications. Two patients are in NYHA Class I, one is in NYHA Class II, and the last in NYHA Class III on a transplant list.

Conclusions:

The one-and-a-half ventricle repair in adult patients is feasible with low mortality. However, advanced age-associated co-morbidities and prolonged chronic RV preoperative dysfunction may jeopardize long-term results when compared to children. doi: 10.1111/jocs.12350(J Card Surg 2014;29:542–545)

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