Contemporary Outcomes for Superior Cavopulmonary Connection in Single Ventricle Palliation: Is There Room for Improvement?

Mohan M. John, Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Children'S Healthcare of Atlanta, Atlanta, GA, USA. mjohn9@emory.edu.
Kevin O. Maher, Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children'S Healthcare of Atlanta, Atlanta, GA, USA.
Marissa Adamson, Department of Pediatrics, Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Ambika Menon, Emory University School of Medicine, Atlanta, GA, USA.
Joshua Qian, Emory University School of Medicine, Atlanta, GA, USA.
Maximilian Brady, Emory University School of Medicine, Atlanta, GA, USA.
Klevi Golloshi, Emory University School of Medicine, Atlanta, GA, USA.
Olivia Cote, Emory University School of Medicine, Atlanta, GA, USA.
Asmita Gathoo, Emory University School of Medicine, Atlanta, GA, USA.
Esha Mohnalkar, Emory University School of Medicine, Atlanta, GA, USA.
Tawanda Zinyandu, Department of Internal Medicine, Bridgeport Hospital, Bridgeport, CT, USA.
Fawwaz R. Shaw, Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Children'S Healthcare of Atlanta, Atlanta, GA, USA.
Shriprasad R. Deshpande, Department of Pediatrics, Division of Cardiology, Georgetown University School of Medicine, Children'S National Hospital, Washington, DC, USA.
Asaad G. Beshish, Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children'S Healthcare of Atlanta, Atlanta, GA, USA.

Document Type

Article

Publication Title

Pediatric cardiology

Abstract

The superior cavopulmonary connection (SCPC) is performed as a part of staged palliation for single ventricle disease. With improvements in interstage management and patient selection, the attrition rate following SCPC is less than 10% in the modern era. We sought to examine the trends and outcomes of SCPC at our institution over the past 14 years. A retrospective review was conducted of patients who underwent SCPC at our institution from 2007 to 2020. Patients were divided into two groups based on date of surgery-pre- 2014 (2007-201) and 2014 + (2014-2020). Demographic and clinical characteristics were compared, along with follow-up survival data. Five hundred and fifty two patients underwent SCPC during the study period, of whom 306 (55.4%) were in the 2014 + era. Patients in the 2014 + era were more likely to be African American (40.2% vs. 31.7%, p = 0.02) or have a genetic abnormality (28.4% vs. 20.6%, p = 0.04). On preoperative echocardiogram, 2014 + patients had more significant (≥ moderate) atrioventricular valve regurgitation (AVVR) (19.6 vs. 10.6%, p = 0.003). Operative and interstage mortality did not differ between eras (p > 0.05). In addition, there was no difference in long-term survival (HR 0.66 [CI 0.34-1.29], p = 0.22) between groups. On multivariable analysis, only ≥ moderate ventricular dysfunction (HR 4.23 [CI 1.18-12.02], p = 0.01) and hypoplastic pulmonary arteries (HR 3.03 [CI 1.17-10.36], p = 0.04) were associated with lower survival. Overall survival following SCPC is excellent, with no improvement in survival in the 2014 + era. More patients with high-risk factors-genetic syndromes and significant AVVR-were operated on in the recent era, without an adverse effect on survival.

DOI

10.1007/s00246-025-03853-1

Publication Date

4-30-2025

Identifier

40304774 (pubmed); 10.1007/s00246-025-03853-1 (doi); 10.1007/s00246-025-03853-1 (pii)

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