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. 2018 Oct 18;5(2):e000902.
doi: 10.1136/openhrt-2018-000902. eCollection 2018.

Survival in patients with univentricular hearts: the impact of right versus left ventricular morphology

Gunnar Erikssen  1 , Jamil Aboulhosn  2 , Jeannette Lin  2 , Knut Liestøl  3 , Mette E Estensen  1 , Ola Gjesdal  1 , Helge Skulstad  4 , Gaute Døhlen  5 , Harald Lauritz Lindberg  6
Affiliations

Survival in patients with univentricular hearts: the impact of right versus left ventricular morphology

Gunnar Erikssen et al. Open Heart. .

Abstract

Objective: Patients with univentricular hearts (UVH) have high mortality despite modern treatment, and better methods to identify patients at highest risk are needed. We wanted to improve risk stratification in patients with UVH by focusing on the prognostic significance of single right versus single left ventricular morphology (SRV vs SLV).

Methods: All 395 patients with UVH operated at our centre were prospectively included from 1972 to 2016 (195 SRV, 166 SLV, 34 mixed or indeterminate ventricular morphology). Diagnoses, UVH morphology, types of all operations and time and causes of death or heart transplantation (HTX) were recorded. The primary endpoint was death or HTX.

Results: Among the 111 non-Fontan patients, 88 died (SRV 62 vs SLV 20; p<0.0001), 32 due to heart failure (SRV 23 vs SLV 5; p=0.0012). Twenty-five years of cumulative SRV versus SLV survival among the 284 Fontan patients (41 deaths/HTX) was 66.9% vs 87.9% (p=0.0027), partly explained by more deaths/HTX due to heart failure among patients with SRV (p=0.0006). Survival in patients with SRV with and without hypoplastic left heart syndrome (HLHS) was similar. SRV versus SLV was a strong predictor of death/HTX in multivariable proportional hazards analyses (RR 3.3, 95% CI 1.6 to 6.6).

Conclusion: SRV versus SLV is a strong short-term and long-term predictor of survival among patients with UVH, mainly explained by higher rates of death/HTX due to heart failure in the SRV group. Our findings apply to patients with SRV both with and without HLHS.

Keywords: congenital heart defects; heart surgery; survival; univentricular hearts; ventricular morphology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Treatment history of 395 study patients with univentricular hearts. BCPC, bidirectional cavopulmonary connection; HTX, heart transplantation; Mix, mixed or indeterminate ventricular morphology; SLV, single left ventricular morphology; SRV, single right ventricular morphology.
Figure 2
Figure 2
Numbers and proportions of different Fontan procedures in different eras.
Figure 3
Figure 3
Cumulative survival in patients with univentricular hearts (UVH). MIX, mixed or indeterminate ventricular morphology; SLV, single left ventricular morphology; SRV, single right ventricular morphology; #, number of patients.
Figure 4
Figure 4
Cumulative survival in Fontan patients with single left ventricular morphology versus single right ventricular morphology with and without hypoplastic left heart syndrome. HLHS, hypoplastic left heart syndrome; SLV, single left ventricular morphology; SRV, single right ventricular morphology; #, number of patients. †p(SLV vs SRV; HLHS only)=0.034. ‡p(SLV vs SRV; HLHS excluded)=0.0018.
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