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Long-Term Surgical Outcomes of Patients With Isomeric Right and Left Atrial Appendages

Lookup NU author(s): Professor Bob Anderson


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© The Author(s) 2023.Objectives: To compare the long-term outcomes of biventricular, univentricular, and so-called one-and-one-half ventricular repairs in patients with left and right isomerism. Methods: Surgical correction was undertaken, between 2000 and 2021, in 198 patients with right, and 233 with left isomerism. Results: The median age at operation was 24 days (interquartile range [IQR]: 18-45) and 60 days (IQR: 29-360) for those with right and left isomerism, respectively. Multidetector computed-tomographic angiocardiography demonstrated more than half of those with right isomerism had superior caval venous abnormalities, and one-third had a functionally univentricular heart. Almost four-fifths of those with left isomerism had an interrupted inferior caval vein, and one-third had complete atrioventricular septal defect. Biventricular repair was achieved in two-thirds of those with left isomerism, but under one-quarter with right isomerism (P <.001). Hazard regression for mortality revealed odds for prematurity at 5.5, pulmonary atresia at 2.81, atrioventricular septal defect with a common valvar orifice at 2.28, parachute mitral valve at 3.73, interrupted inferior caval vein at 0.53, and functionally univentricular heart with a totally anomalous pulmonary venous connection at 3.77. At a median follow-up of 124 months, the probability of survival was 87% for those with left, and 77% for those with right isomerism (P =.006). Conclusions: Multimodality imaging characterizes and delineates the relevant anatomical details, facilitating surgical management of individuals with isomeric atrial appendages. Continuing higher mortality despite surgical intervention in those with right isomerism points to the need for the reassessment of strategies for management.

Publication metadata

Author(s): Chowdhury UK, Anderson RH, Pandey NN, George N, Sankhyan LK, Khan MA, Goja S, Ramakrishnan S, Gupta SK

Publication type: Article

Publication status: Published

Journal: World Journal for Pediatric and Congenital Heart Surgery

Year: 2023

Volume: 14

Issue: 3

Pages: 291-299

Print publication date: 01/05/2023

Online publication date: 16/02/2023

Acceptance date: 23/12/2022

ISSN (print): 2150-1351

ISSN (electronic): 2150-136X

Publisher: SAGE Publications Inc.


DOI: 10.1177/21501351221151049

PubMed id: 36794481


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