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The so-called "one-and-a-half" ventricular repair: Where are we after 40 years?

Lookup NU author(s): Professor Bob Anderson


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© The Author(s), 2023. Published by Cambridge University Press.Objectives: The indications, timing, and results of the so-called "one-and-a-half ventricle repair", as a surgical alternative to the creation of the Fontan circulation, or high-risk biventricular repair, currently remain nebulous. We aimed to clarify these issues. Methods: We reviewed a total of 201 investigations, assessing selection of candidates, the need for atrial septal fenestration, the fate of an unligated azygos vein and free pulmonary regurgitation, the concerns regarding reverse pulsatile flow in the superior caval vein, the growth potential and function of the subpulmonary ventricle, and the role of the superior cavopulmonary connections as an interstage procedure prior to biventricular repair, or as a salvage procedure. We also assessed subsequent eligibility for conversion to biventricular repair and long-term functional results. Results: Reported operative mortalities ranged from 3% to 20%, depending on the era of surgical repair with 7% risk of complications due to a pulsatile superior caval vein, up to one-third incidence of supraventricular arrhythmias, and a small risk of anastomotic takedown of the superior cavopulmonary connection. Actuarial survival was between 80% and 90% at 10 years, with two-thirds of patients in good shape after 20 years. We found no reported instances of plastic bronchitis, protein-losing enteropathy, or hepatic cirrhosis. Conclusions: The so-called "one-and-a-half ventricular repair", which is better described as production of one-and-a-half circulations can be performed as a definitive palliative procedure with an acceptable risk similar to that of conversion to the Fontan circulation. The operation reduces the surgical risk for biventricular repair and reverses the Fontan paradox.

Publication metadata

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

Publication type: Review

Publication status: Published

Journal: Cardiology in the Young

Year: 2023

Volume: 33

Issue: 9

Pages: 1497–1505

Online publication date: 03/07/2023

Acceptance date: 25/05/2023

ISSN (print): 1047-9511

ISSN (electronic): 1467-1107

Publisher: Cambridge University Press


DOI: 10.1017/S1047951123001646

PubMed id: 37394701