Complex Biventricular Repair

Complex biventricular repair and biventricular conversion are treatment options for some children born with a borderline (small) right or left heart. These heart conditions are where one of the heart’s two lower chambers, called ventricles, isn’t large enough or strong enough to work correctly. Most patients with borderline heart traditionally undergo single ventricle palliation.

A biventricular repair involves creating two functioning ventricles in a single procedure.

A biventricular conversion is converting a patient's heart that has been treated with single ventricle palliation to a heart with two pumping ventricles.

If a patient’s ventricle is too small for biventricular repair or immediate biventricular conversion, then the small ventricle may need to be rehabilitated through a series of procedures called “staged recruitment.” The ultimate goal of staged recruitment is a biventricular conversion, converting from a single ventricle circulation to a heart with two pumping ventricles.

The exact type and number of surgeries and procedures each child needs to achieve this conversion varies depending on the child’s heart condition and unique heart anatomy.

Learn more about the Complex Biventricular Repair Program.

Why consider biventricular repair instead of a single ventricle palliation?

Most babies with a single ventricle heart defect have a series of three heart surgeries, called single ventricle palliation, that culminate in the Fontan procedure. These surgeries allow the one working ventricle to do the work of two ventricles.

While this procedure works well for some children, other children experience long-term problems with single-ventricle circulation. Because one ventricle is doing the work of two, pumping blood to both the body and the lungs, it is more likely to get tired. Many children with a single ventricle can develop long-term liver and lung issues and may eventually need a heart transplant.

Due to these concerns, we try, whenever possible, to achieve a two-ventricle (biventricular) heart repair or conversion. We find this approach results in better long-term quality of life for children. To date, many patients have benefitted from these techniques.

Not all patients are candidates for biventricular repair or conversion, and there are risks involved with this type of approach, which is why it is important to have a dedicated team evaluating each patient and monitoring the outcome carefully. Throughout the process, our team of specialists works closely with your family to help you make the right choices for your child.