Health Library

Biventricular Repair

This procedure can be used to treat children born with ventricular problems. It can also treat children who have many different concurrent heart defects and those who have had single-ventricle surgery in the past.

Biventricular Repair for Small Left Ventricle

Biventricular repair can be used to treat children with complicated problems with their left ventricle (the chamber of the heart responsible for pumping oxygenated blood throughout the body). These include:

• The entrance to the chamber is too small.
• The left ventricle chamber is too small.
• The outflow of blood is too low.

For these children, biventricular repair allows the left ventricle to grow and work normally by increasing its size or ability to bring in or pump out blood. Depending on the child’s specific condition, the surgeon may replace different valves, including with living allogenic valve replacement. This type of valve replacement uses donor valves that have the potential to grow with the child, saving the need for multiple surgeries.

Biventricular Repair for Complex Heart Conditions

Biventricular repair can also be a treatment option for children who have many different heart defects from conditions like:

• Heterotaxy syndrome (isomerism)
• Ventricular septal defects
• Unbalanced atrioventricular canal defect

Previously, many of these conditions were treated with single-ventricle repair. This treatment offered a temporary fix for heart defects but required more surgeries down the road. This included a heart transplant in young adulthood.

Biventricular repair can also be used to restore normal circulation for some patients who have previously had single-ventricle repair surgeries like Fontan or Glenn procedures. These patients may be adults when they have biventricular repair. The surgery creates two ventricles from their single ventricle and helps blood flow normally through the four chambers of their heart.

What to Expect Before a Biventricular Repair

For Small Left Ventricle Repair

For children whose left ventricles are too small, doctors have different ways to treat their condition. Treatment will vary depending on their specific condition, but many infants have surgery in the neonatal period (first four weeks of life). This surgery aims to promote growth of the left ventricle and valves until the child can have their full repair around 4 to 7 months old. Many children who have this procedure can go home after their recovery to wait for their biventricular repair.

Some children, especially those who have other complications with their heart and need additional supportive care, may have to stay in the hospital after this initial surgery. Heart surgeons continue to monitor these children and may perform a catheter-based (minimally invasive) procedure. This is a temporary fix that allows the child to go home while waiting for biventricular repair.

Children will have tests, including echocardiograms and magnetic resonance imaging (MRIs), to get a better picture of their hearts before the procedure.

For Complex Heart Repair

Children with complex heart defects, including those who have had surgery before, can have biventricular repair surgery between 6 and 12 months of age. This surgery is performed as a single procedure. All defects are repaired in one session.

Surgeons use virtual modeling to make a “twin” of the child’s heart. They can use this model to walk through the heart, understand the defects and plan the surgery ahead of time to make sure they address all the complications. This planning includes when and where to remove muscle, place patches, replace or repair valves, and more.

This sequenced surgery means children only have to go under anesthesia and through surgery once to repair even very complex defects.

Before their procedure, children will have a CT scan to create the 3D model of their heart. They’ll also have other tests, including:

• Cardiac catheterization, a procedure that uses a thin wire with a camera to get a clear picture of the heart
• Echocardiogram
• MRIs

What to Expect During a Biventricular Repair

Biventricular repair surgery is done under general anesthesia (child is asleep). This procedure is an open-heart surgery that repairs any damaged parts of the heart. What areas get repaired varies depending on the child’s condition. It may include removing muscle or repairing or replacing valves.

For children with small left ventricles, surgery takes three to five hours to complete. For children with many defects being corrected during surgery, the procedure can take 10 to 12 hours.

What to Expect After a Biventricular Repair

After surgery, the time spent recovering in the hospital varies depending on the child’s condition and the specific type of repair they had. On average, children recover in the hospital with consistent monitoring in the days and weeks after their procedure:

• Hybrid procedures (children who had catheter-based procedures before their biventricular repair): six weeks in the hospital
• Repair to expand small chambers of the heart: four weeks in the hospital
• Complex repairs: one to two weeks in the hospital

Your child’s provider will give you the full list of discharge instructions based on your child’s condition. They’ll also help coordinate with your child’s pediatrician and cardiologist for their follow-up care.

Children see their cardiologist within two weeks after their surgery. As they recover, the goal is for them to get down to one visit with their cardiologist every year.

Long-Term Outlook After a Biventricular Repair

Children with biventricular repair will continue to see their cardiologist regularly (once a year for most patients). They can live relatively normal lives.

Biventricular repair is a new procedure, so there is not much information on long-term outcomes for patients. Children who have biventricular repair may need revision surgery to fix problems if they develop. For example, children may need surgery to replace valves that don’t grow with them. The repair could be with catheter procedures or open surgeries.

Unlike single-ventricle repair, children with biventricular repair likely will not need a heart transplant in their 20s or 30s. They are also at a much lower risk of heart failure.

Frequently Asked Questions

What is a biventricular repair?

Biventricular repair is a type of heart surgery that helps create two working pumping chambers in the heart. It may be used to treat children born with certain heart defects or to improve blood flow after earlier surgeries.

How is biventricular repair different from single-ventricle repair?

Biventricular repair aims to restore normal blood flow using both sides of the heart. Single-ventricle repair uses only one pumping chamber and often requires multiple surgeries over time.

What is recovery like after biventricular repair?

Recovery depends on your child’s condition and the type of surgery. Most children stay in the hospital for one to six weeks and need follow-up visits to check heart function as they heal.