Perioperative Outcomes of Noncardiac Surgery in Adults with Single Ventricle Physiology: A Retrospective Cohort Study

Background/Objectives: Adults with single ventricle physiology (SVP) represent a growing population with complex cardiovascular conditions and an increasing need for noncardiac surgery (NCS). However, perioperative outcomes in this group remain poorly characterized. This study aimed to evaluate perioperative complications and mortality in adults with SVP undergoing NCS. Methods: We conducted a retrospective cohort study including all adult patients (≥18 years) with SVP who underwent NCS requiring anesthesia or sedation at a tertiary university hospital between 1 January 1995 and 30 November 2023. Demographic data, comorbidities, type of procedure and anesthetic technique were collected. Complications were defined as intraoperative or postoperative adverse events requiring intervention or associated with hemodynamic, respiratory, or cardiovascular instability. Primary outcomes were perioperative complications and all-cause mortality at 24 hours, 30 days, and one year, analyzed per procedure. Results: A total of 114 procedures were performed in 67 patients (mean age 32.3 ± 10.8 years). Most procedures were elective (78.9%) and minimally invasive, frequently performed under sedation (67.6%). Common comorbidities included arrhythmias (56.1%), liver disease (52.6%), and heart failure (20.2%). The overall complication rate was 6.1% (2.6% intraoperative, 3.5% postoperative). Mortality was 0.9% at 24 hours, 1.8% at 30 days and 3.5% at one year. Adverse outcomes were more frequent in patients with earlier-stage palliation, advanced functional limitation or multiple comorbidities. Conclusions: Perioperative outcomes in adults with SVP undergoing NCS are acceptable when procedures are elective and managed in specialized settings. Risk remains heterogeneous and appears to be influenced by physiological status and stage of palliation.