Posttransplant Outcomes in Pediatric Patients with Univentricular vs. Biventricular Circulation

All articles of this category (opens in new window) Background: Univentricular heart (UVH) circulation is associated with higher baseline mortality and poorer prognosis compared to biventricular heart (BVH) circulation. We aimed to report our center’s experience over the past three decades, analyzing patient profiles, postheart transplantation (HTx) outcomes, and long-term survival. Methods: Between 1988 and 2024, we performed 278 heart transplants in patients with congenital heart defects or cardiomyopathy. Of these, 109 patients (39%) had UVH circulation and 169 (61%) had BVH circulation. We compared pre-HTx characteristics and post-HTx outcomes, performed survival analysis, and constructed a multivariate Cox regression model to identify predictors of long-term survival. Results: Patients with UVH underwent HTx at a significantly younger age than those with BVH (median: 0 years [IQR: 0–4] vs. 4 years [IQR: 1–13], p < 0.001). Among UVH patients, 79% had hypoplastic left heart syndrome. Prior surgical palliation included the Fontan procedure in 27% and the Glenn procedure in 31% of UVH patients. Compared to BVH patients, those with UVH were less likely to receive mechanical circulatory support (MCS) pretransplant (3.8% vs. 21%, p < 0.001). Intraoperatively, UVH patients had significantly longer cardiopulmonary bypass times (median: 297 vs. 231 minutes, p < 0.001) and donor ischemic times (median: 264 vs. 229 minutes, p < 0.001). Post-HTx, 30-day mortality was higher in the UVH group (11% vs. 4.1%, p = 0.027). Multivariate Cox regression analysis demonstrated significantly reduced long-term survival in UVH patients (HR: 2.43; 95% CI: 1.10–5.40; p = 0.029). Conclusion: Patients with UVH circulation continue to experience higher early mortality and reduced long-term survival following HTx compared to those with BVH circulation. These findings highlight the need for tailored perioperative management and meticulous risk stratification in this high-risk population. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany