4:50 PM - 6:20 PM
[II-PD02-05] Univentricular Palliation : Actual Indications and Limitations
Since de first reports of Glenn and Fontan, the univentricular palliation has changed substantially, both in technical terms and in term of results. A brief history is reported, starting with the pioneer works of Glenn, Fontan and Norwood and ending with the actual techniques and results.
Actual selection criteria for univentricular palliation are reviewed, with emphasis on the relationship between these ones and the late outcomes. One of the major limitations of the univentricular circulation is the Fontan failure, which reflects the palliative nature of this operation. The therapeutic options for these patients are mainly reduced to conversion to extra-cardiac conduit type of connection (in those who have an older type of Fontan operation) or heart transplantation.
As an alternative to the univentricular palliation, especially in the setting of left heart obstructive lesions, high risk biventricular repairs should be taken in consideration. Based on the disappointing late outcomes of the Fontan operation, some groups have opted for high risk biventricular procedures in borderline candidates, and their experience has boosted the development of interesting tools to identify those patients who best benefit from these high risk biventricular repairs versus those who are best served by a univentricular palliation.
When the hypoplastic side of the heart is the right one, the one-and-a-half repair may be taken in consideration. Results of this strategy are better when the patient is a sub-optimal biventricular candidate rather than a more typical univentricular one who is forced to maintain some degree of right ventricular load.
Actual selection criteria for univentricular palliation are reviewed, with emphasis on the relationship between these ones and the late outcomes. One of the major limitations of the univentricular circulation is the Fontan failure, which reflects the palliative nature of this operation. The therapeutic options for these patients are mainly reduced to conversion to extra-cardiac conduit type of connection (in those who have an older type of Fontan operation) or heart transplantation.
As an alternative to the univentricular palliation, especially in the setting of left heart obstructive lesions, high risk biventricular repairs should be taken in consideration. Based on the disappointing late outcomes of the Fontan operation, some groups have opted for high risk biventricular procedures in borderline candidates, and their experience has boosted the development of interesting tools to identify those patients who best benefit from these high risk biventricular repairs versus those who are best served by a univentricular palliation.
When the hypoplastic side of the heart is the right one, the one-and-a-half repair may be taken in consideration. Results of this strategy are better when the patient is a sub-optimal biventricular candidate rather than a more typical univentricular one who is forced to maintain some degree of right ventricular load.