Ventricular morphology of single-ventricle hearts has a significant impact on outcomes after Fontan palliation: a meta-analysis

Authors

Matteo Ponzoni, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Pediatric and Congenital Cardiac Surgery Unit, University of Padova Medical School, Padova, Italy.
Danila Azzolina, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Unit of Biostatistics, University of Padova Medical School, Padova, Italy.
Luca Vedovelli, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Unit of Biostatistics, University of Padova Medical School, Padova, Italy.
Dario Gregori, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Unit of Biostatistics, University of Padova Medical School, Padova, Italy.
Giovanni Di Salvo, Department of Woman and Child's health, Pediatric Cardiology Unit, University of Padova Medical School, Padova, Italy.
Yves D'Udekem, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Vladimiro Vida, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Pediatric and Congenital Cardiac Surgery Unit, University of Padova Medical School, Padova, Italy.
Massimo A. Padalino, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Pediatric and Congenital Cardiac Surgery Unit, University of Padova Medical School, Padova, Italy.

Document Type

Journal Article

Publication Date

11-3-2022

Journal

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

Volume

62

Issue

6

DOI

10.1093/ejcts/ezac535

Keywords

Fontan; Meta-analysis; Ventricular morphology

Abstract

OBJECTIVES: A conclusive interpretation of the role of ventricular dominance in outcomes after Fontan palliation has not been formulated yet. We conducted a systematic review and meta-analysis of scientific literature to give an insight into the impact of ventricular morphology in single-ventricle palliation, focusing on its influence on survival, morbidities, ventricular performance and functional capacity. METHODS: A systematic review of PubMed, Web of Science and Scopus databases was performed. A random-effect meta-analysis was conducted, and survival data were reconstructed using the published Kaplan-Meier survival curves. RESULTS: Twenty-seven studies were selected, for a total of 4529 left-dominant versus 4844 right-dominant patients. Estimated survival at 1, 5, 10, 20 and 30 years of follow-up was 0.99 [95% confidence interval (CI) = 0.98-0.99], 0.95 [95% CI = 0.94-0.96], 0.92 [95% CI = 0.91-0.93], 0.86 [95% CI = 0.84-0.88] and 0.68 [95% CI = 0.65-0.83] for left-dominant patients and 0.94 [95% CI = 0.93-0.95], 0.89 [95% CI = 0.88-0.9], 0.85 [95% CI = 0.83-0.87], 0.69 [95% CI = 0.63-0.75] and 0.59 [95% CI = 0.5-0.69] for right-dominant patients, respectively. Survival was statistically lower for right-dominant patients (P < 0.001), with an hazard ratio for the mortality of 2.38 (2.03-2.80); also, they displayed significantly longer hospital stay, worse ventricular function, larger ventricular volumes and a higher incidence of moderate or severe atrioventricular valve regurgitation when compared to left-dominant patients. CONCLUSIONS: According to our meta-analysis, the morphology of the dominant ventricle has a significant impact on outcomes after Fontan palliation. Right-dominant patients experience an inferior long-term survival when the anatomical right ventricle is included in the systemic circulation.

APA Citation

Ponzoni, Matteo; Azzolina, Danila; Vedovelli, Luca; Gregori, Dario; Di Salvo, Giovanni; D'Udekem, Yves; Vida, Vladimiro; and Padalino, Massimo A., "Ventricular morphology of single-ventricle hearts has a significant impact on outcomes after Fontan palliation: a meta-analysis" (2022). GW Authored Works. Paper 1973.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1973

Department

Surgery