Single-stage ventricular septation for double-inlet left or right ventricle (DILV
or DIRV) has historically been associated with poor outcomes. We hypothesize that
staged ventricular septation may demonstrate favorable clinical outcomes to be an
alternative to Fontan palliation. This single-center retrospective study reviewed
patients with DILV or DIRV who underwent staged ventricular septation between 2015–2021.
The strategy involves pulmonary artery banding or Norwood procedure during infancy
(stage 1), followed by partial ventricular septation to anchor the septum, while maintaining
systemic RV pressure to avoid septal shift (stage 2). Residual septal defects are
closed with pulmonary artery band removal at stage 3. Results are reported as median
(interquartile range). Twelve patients underwent partial ventricular septation. At
a median follow-up time of 17 months (8–30) after stage 2, there were no interstage
deaths or cardiac transplants; LV dysfunction was observed in one patient. Hemodynamic
evaluation after stage 2 demonstrated median left atrial pressure of 9.5 mm Hg (8.9–11.5),
cardiac index of 3.4 L/min/m2 (3.2–3.6), and RV and LV indexed end-diastolic volumes of 52 ml/m2 (41–67) and 105 ml/m2 (81–115), respectively. Five patients have progressed to stage 3; one required pacemaker
for complete heart block. Unplanned reintervention was required in 4 patients after
stage 1, 2 patients after stage 2, and 3 patients after stage 3. Staged ventricular
septation is an alternative to single-ventricle palliation in a subset of double-inlet
ventricle patients and is associated with acceptable early outcomes. Further studies
are necessary to determine long-term outcomes.
Graphical Abstract
Graphical Abstract
Keywords
Abbreviations:
AV (Atrioventricular), BDG (Bidirectional Glenn), DILV (Double-inlet left ventricle), DIRV (Double-inlet right ventricle), DKS (Damus-Kaye-Stansel), IQR (Interquartile range), IVC (Inferior vena cava), LV (Left ventricle), PA (Pulmonary artery), RV (Right ventricle), VSD (Ventricular septal defect)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 07, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Read at the AATS 102nd Annual Meeting, May 14-17, 2022, Boston, MA.
Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Disclosures: Authors have no financial interest or affiliation concerning material discussed in this manuscript.
IRB Number: P00040200
IRB Date of Approval: 11/9/2021
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