SCPC Care: Non-Age-Related Factors Contribute to Timing

August 12, 2026

A recent publication from Phoenix Children’s Center for Heart Care in suggests providers look beyond age-based timing when planning superior cavopulmonary connection (SCPC), also known as the bidirectional Glenn procedure, for children with single-ventricle heart defects. Instead, this article published in Future Cardiology, suggests a structured assessment of various physiologic risk factors may improve a patient’s postoperative results. The authors propose that a structured assessment of physiologic readiness, combined with targeted treatment of modifiable risk factors may improve postoperative recovery and long term outcomes.

“Over the past decade, there has been a growing body of knowledge identifying factors that influence outcomes following SCPC that are spread across surgical, cardiology and quality-improvement literature,” said Arash Sabati, MD, pediatric cardiologist and Director of Research at the Center for Heart Care at Phoenix Children’s. “The central message of our team’s review is that outcomes after superior cavopulmonary connection can be improved through a systematic evaluation of modifiable risk factors before surgery.”

A Pivot Away from Age

Timing for SCPC matters because it can affect the length of a child’s hospital stay and their other postoperative outcomes, Dr. Sabati said. Historically, patient age has played a prominent role in surgery planning dividing programs into those who did “early SCPC” and those who did not. However, the literature does not identify a universally optimal age for every patient. Instead, providers should individualize the timing based on the patient’s overall physiologic readiness.

“Chronological age remains important, but it’s only one piece of a much larger picture” he said. “A younger infant who is growing well and has favorable hemodynamics may be a better candidate than an older infant with significant residual lesions or poor growth.”

Based on their findings from a literature review and their own experience, the team compiled a list of factors that providers should evaluate before recommending surgery, including:

Adequate weight gain and nutritional status
Catheterization hemodynamics, including filling pressures and pulmonary vascular resistance
Degree of atrioventricular valve regurgitation
Presence of aortic arch obstruction or other residual lesions
Pulmonary artery size and architecture
Respiratory status and need for supplemental support
Stable oxygen saturations and clinical condition
Ventricular systolic function

A Shift in Patient Evaluation

To improve patient outcomes, the Phoenix Children’s team is focused on evaluation of physiologic problems that may interfere with surgery or postoperative recovery.

“Many issues are potentially treatable if identified early, when intervention before SCPC may improve outcomes,” he said. “For example, ventricular dysfunction or moderate or greater atrioventricular valve regurgitation may be worsened by aortic arch obstruction, and a balloon angioplasty or surgical arch revision may help mitigate or relieve any worsening in either area.”

Providers should consider referral for patients presenting with any of the following before SCPC:

Aortic arch obstruction
Increasing need for respiratory support
Increasing oxygen requirements
Moderate or greater atrioventricular valve regurgitation
Poor weight gain or failure to thrive (these children are more likely to require transplant)
Recurrent pleural effusions
Restrictive atrial septal communication
Suspected branch pulmonary artery stenosis
Ventricular dysfunction
Worsening cyanosis

The Phoenix Children’s team encourages providers to give close attention to children with viral respiratory infections. In some cases, these illnesses can postpone SCPC, putting patients at greater risk. Available evidence suggests that an asymptomatic child with a positive viral test may not necessarily experience worse postoperative outcomes. Symptomatic respiratory infection, however, may increase perioperative risk and often warrants postponing elective surgery until the child has recovered.

This decision requires careful balance. Delaying surgery may reduce immediate respiratory risk, but it also keeps the child in the higher-risk interstage period

The Value of Early Referral

Patients with single-ventricle heart defects require complex care. Phoenix Children’s Center for Heart Care offers the advanced services needed to evaluate and manage children with this condition. Early referrals to the program improve the patient’s chances for a positive surgical experience.

“Early involvement from our team allows for multidisciplinary review by cardiology, cardiac surgery, imaging, catheterization, nutrition and intensive care teams,” he said. “In many cases, identifying and addressing residual lesions before surgery can significantly influence outcomes and shorten recovery.”

Long-Term Change for SCPC Care

Care for single-ventricle heart defects is evolving within the fields of pediatric cardiology and congenital cardiac surgery, Dr. Sabati said. These findings from the team at Phoenix Children’s highlight the need for greater focus on the “interstage period” before SCPC – those days, weeks or months when children need additional care for other concurrent health concerns.

Taking the time to examine these problems is critical, he said. A comprehensive preoperative evaluation can reveal problems and give providers an opportunity to create a personalized care plan. Through a thorough evaluation, care teams can optimize growth and hemodynamics while setting the stage for long-term neurodevelopmental, functional, and behavioral results.

“Successful SCPC begins long before the operation itself,” he said. “Careful multidisciplinary attention to factors that aren’t related to a patient’s age can meaningfully influence both short- and long-term outcomes.”

Refer a Patient or Request a Consult

Phoenix Children's Center for Heart Care provides comprehensive, multidisciplinary evaluation and management for patients with single-ventricle congenital heart disease – including preoperative optimization, catheterization, imaging, nutrition and intensive care support before SCPC and throughout the surgical staging pathway. To refer a patient or request a consultation, call 602-933-KIDS (5437) or submit a referral online.

Source:

Sabati, A., Alaeddine, M., Quinones-Carrasquillo, S., Almasarweh, S., & Bhat, D. (2025). Optimizing outcomes for patients undergoing superior cavopulmonary connection procedure: what we know. Future Cardiology, 21(12), 1177–1185. https://doi.org/10.1080/14796678.2025.2598218