Date of Award

January 2017

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

James Y. Yun



Melissa A. Herrin and Sitaram M. Emani. Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA. (Sponsored by James J. Yun, Department of Surgery, Yale University School of Medicine.)

Patients with borderline left heart, hypoplastic left heart syndrome variant (bHLHS) or unbalanced atrioventricular canal (uAVC), who undergo initial single ventricle palliation may be candidates for biventricular (BiV) conversion following left ventricle (LV) recruitment procedures. Our objective was to investigate the association between preoperative parameters and postoperative outcomes in a cohort of patients undergoing BiV conversion. We performed a retrospective review of patients who underwent BiV conversion to determine variables associated with clinical outcomes. Predictor variables included cardiac diagnosis, age and weight, LV dimension, LV end diastolic volume, LV mass, preoperative LV end diastolic pressure (LVEDP), and preoperative left atrial pressure. Primary outcome was a composite of death, heart transplant, or BiV reversal to SVP (reversal). Of 51 patients, 11 experienced primary outcome (22%). Patients with bHLHS were more likely to experience primary outcome than those with uAVC (30% vs. 6%, P = .03). Receiver operating characteristic analysis demonstrated that preoperative LVEDP had good predictive accuracy in classifying patients with and without the primary outcome (area under the curve = 0.757, 95% confidence interval: 0.594 - 0.919, P = .012). The Youden J-index indicated a cutoff of LVEDP ≥ 13 mmHg as optimal for predicting the primary outcome. Multivariable Cox regression demonstrated that LVEDP > 13 mmg was associated with primary outcome, independent of age, weight, gender and diagnosis (adjusted hazard ratio = 4.00, P = .037). Multivariable Cox regression analysis also demonstrated that elevated postoperative right ventricular pressure (>3/4 systolic blood pressure) was significantly associated with primary outcome (adjusted hazard ratio =21.75, P< .001) independent of age, weight, and diagnosis. Elevated preoperative LVEDP is a risk factor for suboptimal postoperative hemodynamics and adverse following BiV conversion after single ventricle palliation.


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