Heart transplantation is the treatment of choice in case of severely impaired function of the functionally single ventricle (44). exceeds the one following other operations in ACHD. Currently, different devices are used and new technical developments are in progress. However, there still is no ideal assist device available. Therefore, heart transplantation remains the only valid option for end-stage CHD. Despite higher early mortality following heart transplantation in ACHD compared to non-ACHD, the long-term survival compares favorably to non-ACHD. There is room for improvement by refining the indications, the time of listing, and the perioperative care of ACHD transplant patients. Sudden death 3-Hydroxydodecanoic acid is the second most frequent cause of mortality in ACHD. Ventricular tachycardia is the most frequent cause of sudden death followed by coronary artery anomaly. Due to the increasing awareness of physicians and the improved imaging techniques, coronary artery anomalies are coming more into the focus of cardiac surgeons. However, the reported experience is limited and it is currently difficult to provide a standardized and generally applicable recommendation for the indication and the adequate surgical technique. With the increasing age and complexity of ACHD, treatment of rhythm 3-Hydroxydodecanoic acid disturbances by surgical ablation, pacemaker or implantable cardioverter defibrillator (ICD) implantation and resynchronisation gains importance. A risk score specifically designed for surgery in ACHD is among the newest developments 3-Hydroxydodecanoic acid in predicting the outcome of surgical treatment of ACHD. This evidence-based score, derived from and validated with data from the Society of Thoracic Surgeons Congenital Heart Medical procedures Database, enables comparison of risk-adjusted performance of the whole spectrum of procedures performed in ACHD and helps in understanding the differences in surgical outcomes. The score is usually thus a powerful tool for quality control and quality improvement. In conclusion, new developments in surgery for ACHD are currently made with regard to valve surgery, which comprises more than half of all operations in ACHD and in treatment of end-stage CHD, which still yields high mortality and morbidity. coronary explantation and reimplantation (20). Meticulous preoperative imaging of coronary anatomy is usually therefore essential, given that these patients often present 3-Hydroxydodecanoic acid with an abnormal course of the coronary arteries (21). Multivalve surgery is also common in ACHD, with the tricuspid and PV being the most common combination (22). Early mortality following multivalve surgery was reported to be 4.7% and thus above the average early mortality following surgery in ACHD, with longer bypass and ischemic time as the main determinants for adverse outcome (22). It is therefore comprehensible, that surgeons sometimes refrain from extensive, time-consuming valve sparing techniques, and opt for a quick replacement. New techniques for valve replacement As an alternative for mechanical or biological valve substitutes, cusp replacement by means of the Ozaki operation has become more and more popular, also as an option for ACHD (23,24). The results may depend around the tissue used as cusp substitute, with autologous pericardium yielding the most promising results (25,26). Unfortunately, the quantity and the quality of autologous pericardium are limited in ACHD undergoing repeat sternotomy. The ideal valve for replacement of the AV may be the autologous PV (27). However, the Ross operation performed as full root 3-Hydroxydodecanoic acid replacement leads to dilatation and Rabbit polyclonal to KATNB1 subsequent autograft failure (28). Therefore, some centers now prefer the reinforced Ross technique. The autograft is usually sutured into a tube graft prior to the implantation into the left ventricular outflow (29,30). This is essentially a combination of the David and the Ross operation. There is no long-term experience with this procedure so far, but it seems to.