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Survival in patients with univentricular hearts: the impact of right versus left ventricular morphology
OBJECTIVE: Patients with univentricular hearts (UVH) have high mortality despite modern treatment, and better methods to identify patients at highest risk are needed. We wanted to improve risk stratification in patients with UVH by focusing on the prognostic significance of single right versus singl...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196969/ https://www.ncbi.nlm.nih.gov/pubmed/30364544 http://dx.doi.org/10.1136/openhrt-2018-000902 |
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author | Erikssen, Gunnar Aboulhosn, Jamil Lin, Jeannette Liestøl, Knut Estensen, Mette E Gjesdal, Ola Skulstad, Helge Døhlen, Gaute Lindberg, Harald Lauritz |
author_facet | Erikssen, Gunnar Aboulhosn, Jamil Lin, Jeannette Liestøl, Knut Estensen, Mette E Gjesdal, Ola Skulstad, Helge Døhlen, Gaute Lindberg, Harald Lauritz |
author_sort | Erikssen, Gunnar |
collection | PubMed |
description | OBJECTIVE: Patients with univentricular hearts (UVH) have high mortality despite modern treatment, and better methods to identify patients at highest risk are needed. We wanted to improve risk stratification in patients with UVH by focusing on the prognostic significance of single right versus single left ventricular morphology (SRV vs SLV). METHODS: All 395 patients with UVH operated at our centre were prospectively included from 1972 to 2016 (195 SRV, 166 SLV, 34 mixed or indeterminate ventricular morphology). Diagnoses, UVH morphology, types of all operations and time and causes of death or heart transplantation (HTX) were recorded. The primary endpoint was death or HTX. RESULTS: Among the 111 non-Fontan patients, 88 died (SRV 62 vs SLV 20; p<0.0001), 32 due to heart failure (SRV 23 vs SLV 5; p=0.0012). Twenty-five years of cumulative SRV versus SLV survival among the 284 Fontan patients (41 deaths/HTX) was 66.9% vs 87.9% (p=0.0027), partly explained by more deaths/HTX due to heart failure among patients with SRV (p=0.0006). Survival in patients with SRV with and without hypoplastic left heart syndrome (HLHS) was similar. SRV versus SLV was a strong predictor of death/HTX in multivariable proportional hazards analyses (RR 3.3, 95% CI 1.6 to 6.6). CONCLUSION: SRV versus SLV is a strong short-term and long-term predictor of survival among patients with UVH, mainly explained by higher rates of death/HTX due to heart failure in the SRV group. Our findings apply to patients with SRV both with and without HLHS. |
format | Online Article Text |
id | pubmed-6196969 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-61969692018-10-25 Survival in patients with univentricular hearts: the impact of right versus left ventricular morphology Erikssen, Gunnar Aboulhosn, Jamil Lin, Jeannette Liestøl, Knut Estensen, Mette E Gjesdal, Ola Skulstad, Helge Døhlen, Gaute Lindberg, Harald Lauritz Open Heart Congenital Heart Disease OBJECTIVE: Patients with univentricular hearts (UVH) have high mortality despite modern treatment, and better methods to identify patients at highest risk are needed. We wanted to improve risk stratification in patients with UVH by focusing on the prognostic significance of single right versus single left ventricular morphology (SRV vs SLV). METHODS: All 395 patients with UVH operated at our centre were prospectively included from 1972 to 2016 (195 SRV, 166 SLV, 34 mixed or indeterminate ventricular morphology). Diagnoses, UVH morphology, types of all operations and time and causes of death or heart transplantation (HTX) were recorded. The primary endpoint was death or HTX. RESULTS: Among the 111 non-Fontan patients, 88 died (SRV 62 vs SLV 20; p<0.0001), 32 due to heart failure (SRV 23 vs SLV 5; p=0.0012). Twenty-five years of cumulative SRV versus SLV survival among the 284 Fontan patients (41 deaths/HTX) was 66.9% vs 87.9% (p=0.0027), partly explained by more deaths/HTX due to heart failure among patients with SRV (p=0.0006). Survival in patients with SRV with and without hypoplastic left heart syndrome (HLHS) was similar. SRV versus SLV was a strong predictor of death/HTX in multivariable proportional hazards analyses (RR 3.3, 95% CI 1.6 to 6.6). CONCLUSION: SRV versus SLV is a strong short-term and long-term predictor of survival among patients with UVH, mainly explained by higher rates of death/HTX due to heart failure in the SRV group. Our findings apply to patients with SRV both with and without HLHS. BMJ Publishing Group 2018-10-18 /pmc/articles/PMC6196969/ /pubmed/30364544 http://dx.doi.org/10.1136/openhrt-2018-000902 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Congenital Heart Disease Erikssen, Gunnar Aboulhosn, Jamil Lin, Jeannette Liestøl, Knut Estensen, Mette E Gjesdal, Ola Skulstad, Helge Døhlen, Gaute Lindberg, Harald Lauritz Survival in patients with univentricular hearts: the impact of right versus left ventricular morphology |
title | Survival in patients with univentricular hearts: the impact of right versus left ventricular morphology |
title_full | Survival in patients with univentricular hearts: the impact of right versus left ventricular morphology |
title_fullStr | Survival in patients with univentricular hearts: the impact of right versus left ventricular morphology |
title_full_unstemmed | Survival in patients with univentricular hearts: the impact of right versus left ventricular morphology |
title_short | Survival in patients with univentricular hearts: the impact of right versus left ventricular morphology |
title_sort | survival in patients with univentricular hearts: the impact of right versus left ventricular morphology |
topic | Congenital Heart Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196969/ https://www.ncbi.nlm.nih.gov/pubmed/30364544 http://dx.doi.org/10.1136/openhrt-2018-000902 |
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