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What are complex biventricular repair and biventricular conversion?

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.

Complex Biventricular Repair | Frequently Asked Questions

How many procedures are involved in biventricular conversion?

A complex biventricular conversion can involve many surgeries and procedures (staged recruitment) over several months or years. By performing the conversion slowly, in several stages, we can carefully monitor the child’s heart and make sure it can tolerate each step of the procedure before we move forward with the next step.

Exactly how long the conversion takes will depend on your child’s specific heart condition, what types of surgeries he or she has already had, and his or her overall health.

At what age do you perform complex biventricular conversion?

Ideally, we prefer to begin the conversion after a child has had their stage 1 procedure, around the time of their stage 2 bidirectional Glenn procedure, usually at about 3 to 6 months of age. We prefer to begin the conversion before a child has had a Fontan procedure, but in some cases we can do it after a Fontan.

What are the risks of complex biventricular repair and conversion?

The risks and complications of biventricular repair and conversion vary greatly depending on the type of heart defect and your child’s overall health. Your child’s cardiologist will discuss your child’s individual risks with you.

There is a general risk that comes with having many procedures and surgeries on the heart. There is also a risk for heart failure if the heart can’t tolerate the conversion to biventricular circulation. However, we perform the procedure in stages to minimize this risk. This allows us to make sure the heart can tolerate one procedure before we move on to the next step.

What is the long-term outlook after a biventricular repair or conversion?

Most children who have a biventricular repair or conversion do very well, and their outlook continues to improve. We find these children enjoy more stamina and a better quality of life than children with single ventricle palliation. They also tend to have fewer long-term complications.

Children who have a biventricular repair or conversion will need to be followed and monitored throughout their lives by a cardiologist.

Complex Biventricular Repair | Programs & Services