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We aim to assess the outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Data of 27 patients with borderline left ventricle that had undergone biventricular repair in our centers in the past 20 years (median follow-up: 5 years) were analyzed retrospectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Successful primary repair was performed in 17 (63%) patients. Four (15%) patients initially underwent primary repairs, which were converted to Norwood reconstructions, hoping to re-attempt biventricular repair later. Primary Norwood reconstruction with a restrictive atrial septal defect or its hybrid equivalent were performed in 6 patients (2 Norwoods [7%], 4 Hybrids [15%]) for ventricular rehabilitation, with subsequent biventricular repair a few months later. The total number of procedures was 87 (average: 3.2 per patient). These figures do not include procedures for implantation of ECMO, re-operations for bleeding and delayed sternal closures because we consider these as parts of the procedures that immediately preceded them. This strategy failed in 8 (30%) patients: 7 died (4 within 1 year, 1 at 18 months, 1 at 3 years, 1 at 3.5 years), and 1 was converted to univentricular palliation eventually reaching Fontan completion. Four (15%) patients reached favorable outcomes: alive and asymptomatic with biventricular circulation, good ventricular function and normal-sized valves. The remaining 15 (55%) patients are alive but with residual lesions, which may include ventricular diastolic dysfunction, somewhat small mitral and\/or aortic valves and pulmonary hypertension; 9 are in NYHA class I and 6 in class II.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The results are suboptimal. Further studies are needed to identify ways of predicting who would benefit most from aggressively pursuing a biventricular strategy and offer it to them selectively.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13019-026-04531-w","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T18:04:53Z","timestamp":1784311493000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcome of biventricular repair of congenital cardiac malformations with a borderline left ventricle"],"prefix":"10.1186","volume":"21","author":[{"given":"Emilie","family":"Houdebert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria Benito","family":"Arnaiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Gonzalez-Calle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Rady","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Scopetani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Boni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria-Helena","family":"Perez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Sekarski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Di Bernardo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Parry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir-Reza","family":"Hosseinpour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"4531_CR1","doi-asserted-by":"publisher","first-page":"101429","DOI":"10.1016\/j.jacadv.2024.101429","volume":"4","author":"MB Ghbeis","year":"2025","unstructured":"Ghbeis MB, Pane C, Beroukhim R, Feins E, Del Nido PJ, Sleeper LA, et al. 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