1. Outcomes of atrioventricular valve operation in patients with Fontan circulation.
- Author
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Liu VJ, Yong MS, d'Udekem Y, Weintraub RG, Praporski S, Brizard CP, and Konstantinov IE
- Subjects
- Child, Preschool, Female, Heart Defects, Congenital complications, Heart Defects, Congenital mortality, Heart Transplantation, Heart Valve Diseases congenital, Heart Valve Diseases mortality, Humans, Infant, Male, Retrospective Studies, Treatment Outcome, Cardiac Valve Annuloplasty, Fontan Procedure, Heart Defects, Congenital surgery, Heart Valve Diseases surgery, Mitral Valve abnormalities, Tricuspid Valve abnormalities
- Abstract
Background: Data on outcomes of atrioventricular (AV) valve surgical procedures in patients with Fontan circulation are limited., Methods: We conducted a retrospective review of all children with Fontan circulation who underwent AV valve operations., Results: From 1981 to 2014, 581 patients underwent Fontan operations, and 9.3% (54/581) of them required AV valve operations. The first AV valve operation was performed before (n = 32), during (n = 15), or after (n = 7) the Fontan operation. The mean follow-up time was 9.8 ± 7.1 years (range, 6 months to 32 years). Operative mortality for the initial AV valve operation was 1.9% (1/54) and occurred in a patient who had the initial valve operation concomitantly with the Fontan. Late mortality was 5.7% (3/53). Heart transplantation was performed in 13.0% (7/54) of patients. Freedom from death or transplantation after the first AV valve operation was 89.8 ± 4.4% at 5 years (95% confidence interval [CI], 77.1 to 95.6) and 81.0 ± 6.2% at 10 years (95% CI, 65.0 to 90.2). Reoperation on the AV valve was performed in 44.4% (24/54) of patients. The median time to initial valve reoperation was 3.1 years (interquartile range, 0.8 to 7.4 years). Freedom from reoperation or transplantation was 63.4 ± 7.0% at 5 years (95% CI, 48.2 to 75.3) and 48.9 ± 7.9% at 10 years (95% CI, 32.8 to 63.2). Freedom from moderate or more regurgitation in patients who had not undergone reoperation or transplantation was 74.0 ± 6.9% (95% CI, 57.5 to 84.8) at 5 years and 67.5 ± 7.7% (95% CI:,50.0 to 80.0) at 10 years. After initial valve operation, thromboembolic events occurred in 13.0% (7/54) of patients, stroke occurred in 24.1% (13/54) of patients, pacemaker insertion was required in 16.7% (9/54) of patients, and protein-losing enteropathy was diagnosed in 7.4% (4/54) of patients. Of the 43 surviving transplant-free patients, 62.8% (27/43) were in New York Heart Association (NYHA) class I, 34.9% (15/43) were in NYHA class II, and 1 patient was in NYHA class III., Conclusions: The AV valve operation done before, during, or after the Fontan operation is associated with low operative mortality but a high reoperation rate with significant risk of late death, transplantation, and persistent AV valve regurgitation., (Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
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