• Ajami Gikandi, Jocelyn Davee, Edward T O'Leary, Elizabeth S DeWitt, Sunil J Ghelani, Rebecca S Beroukhim, Edward P Walsh, Pedro J Del Nido, Eric N Feins, and Sitaram M Emani.
• Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
• J. Thorac. Cardiovasc. Surg. 2024 Sep 26.

ObjectivesAlthough conduction location can reliably be predicted in double inlet ventricle (DIV), ventricular septation continues to carry a significant risk of CHB. This study describes our experience with ventricular septation and intraoperative conduction mapping.MethodsPatients undergoing ventricular septation from 2017-2023 were identified. Conduction mapping was performed on the open, decompressed, beating heart to identify the His bundle. Mapped His bundle locations were compared to those predicted from MRI diagnoses by a senior pediatric cardiac electrophysiologist blinded to mapping results.ResultsVentricular septation was performed in 31 patients, 25 with hypoplastic RV and 6 with hypoplastic LV. Two-stage septation was performed in 25 patients and single-stage septation in 6. Mapped was performed in the last 25 consecutive patients. Mapped conduction location was concordant with expected location in 21/22 patients with predictions. CHB requiring a permanent pacemaker occurred in 4 patients despite successful mapping, while 10 patients required other reoperations, most commonly to address residual AV valve regurgitation or subpulmonary obstruction from the VSD patch. There has been no perioperative mortality, need for single-ventricle palliation or heart transplantation. All 13 patients who have progressed to complete septation and 18 patients with interstage circulation have acceptable hemodynamics, preserved ventricular function, and no heart failure symptoms at latest follow-up.ConclusionsVentricular septation represents an alternative to Fontan that can be performed safely in a subset of patients with acceptable early outcomes. Conduction mapping is an adjunct strategy that may add precision to the well-established rules for reliably predicting conduction location.Copyright © 2024. Published by Elsevier Inc.

5 keywords...

hide…