SURGERY FOR NEONATES WITH UNIVENTRICULAR PHYSIOLOGY: DATA FROM THE EUROPEAN CONGENITAL HEART SURGEONS ASSOCIATION CONGENITAL DATABASE

Background and Aim: Patients with univentricular physiology pose a particular challenge, especially during the neonatal period. This study aimed to evaluate the outcomes of cardiac surgery in neonates with univentricular congenital heart disease (uCHD) over the past decade, using data from the European Congenital Heart Surgeons Association Congenital Database (ECHSA-CD). Methods: All neonates with uCHD who underwent Norwood Operation or Hybrid palliation within the first 30 days of life were selected from the ECHSA-CD database (January 2013 to December 2022). Patients who underwent exclusively percutaneous procedures were excluded. The primary outcome was operative mortality (death within the first 30 days post-operation or during the same hospitalization). Logistic regression was used to conduct a multivariable analysis. Results: A total of 2,700 neonatal patients with single ventricle physiology were identified in the ECHSA-CD during the study period. Hypoplastic left heart syndrome (HLHS) was the most common diagnosis (2,150/2,700=79.6%). Norwood Operation was performed in 2,115/2,700=78.3% patients and Hybrid procedure in 585/2,700=21.7% patients. While Hybrid procedure patients exhibited higher operative mortality than Norwood Operation in the overall population (182/585=31.1% vs 525/2,115=24.8%; p=0.002), this trend was reversed in patients with a body weight ≤2.5 kg (30/94=31.9% vs 38/75=50.7%, respectively; OR=0.46 (0.24-0.85) p=0.01). Patients with HLHS showed higher mortality compared to other types of uCHD (581/2,150=27.0% vs 126/550=22.9%; p=0.05). Conclusions: uCHD remains a significant challenge in congenital heart surgery, associated with notable mortality, especially in low-birth weight neonates.