Can We Still Improve Survival Outcomes of Neonatal Biventricular Repairs?

Shuhua Luo, Christoph Haller, Chun po Steve Fan, Kasey Moss, Cedric Manlhiot, Wenli Xie, Ali Moinshaghaghi, Maruti Haranal, Steven Schwartz, Christopher Caldarone, Glen S. Van Arsdell, Osami Honjo

Research output: Contribution to journalArticlepeer-review


Background: We sought to identify modifiable factors to improve survival of neonatal biventricular repair by analyzing the cause of death and predictors of mortality and reintervention in the last 2 decades. Methods: Between 1995 and 2016, 991 consecutive neonates were included. The cohort was divided by era: era I was from 1995 to 1999, era II 2000 to 2007, and era III 2008 to 2016. The Kaplan-Meier method was used to estimate freedom from death and reintervention. Univariable and multivariable Cox regression was applied to assess predictors for mortality or reintervention in the contemporary cohorts (2000-2016). Results: Median age was 8 days (range, 5-13), and median body weight at operation was 3.3 kg (range, 2.9-3.6). The most common diagnosis was transposition with intact ventricular septum (32%), followed by transposition with ventricular septal defect (14.5%), and simple left-to-right shunt lesion (10.9%). There was significant improvement in survival from era I to eras II and III but no difference between eras II and III (1 year: 82.1% vs 89.4% vs 89.6%, respectively; P <.001). The most common cause of death was sudden death in eras I and III and cardiac in era II. Multivariable analysis revealed preoperative (P =.005)/postoperative (P <.001) extracorporeal membrane oxygenation and postoperative renal replacement (P <.001) as independent predictors for mortality. The reintervention rates were comparable between eras II and III (P =.53). Atrioventricular septal defects and common atrial trunk were identified as predictors for reintervention. Conclusions: Survival after neonatal biventricular repair remained unchanged. Preventing sudden death, myocardial protection, and minimizing residual lesions are potential targets to improve outcomes.

Original languageEnglish (US)
Pages (from-to)199-205
Number of pages7
JournalAnnals of Thoracic Surgery
Issue number1
StatePublished - Jan 2021
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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