Results of Fontan operation in patients with atrioventricular valve regurgitation

OBJECTIVES The influence of concomitant atrioventricular valve regurgitation on the results of Fontan operation remains disputable. The goal of this study was to compare early and late results of Fontan operation performed in patients with mild or moderate-to-severe atrioventricular valve regurgitat...

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Published in:	European journal of cardio-thoracic surgery Vol. 48; no. 2; pp. 308 - 315
Main Authors:	Podzolkov, Vladimir P., Chiaureli, Mikhail R., Yurlov, Ivan A., Zelenikin, Mikhail M., Kovalev, Dmitry V., Dontsova, Vera I., Astrakhantseva, Tatiana O., Putiato, Neele A., Zaets, Sergey B.
Format:	Journal Article
Language:	English
Published:	Germany Oxford University Press 01-08-2015
Subjects:	Adolescent Child Child, Preschool Critical Care - methods Female Fontan Procedure - adverse effects Fontan Procedure - methods Heart Defects, Congenital - complications Heart Defects, Congenital - physiopathology Heart Defects, Congenital - surgery Hemodynamics - physiology Humans Kaplan-Meier Estimate Male Postoperative Care - methods Postoperative Period Retrospective Studies Severity of Illness Index Treatment Outcome Tricuspid Valve Insufficiency - complications Tricuspid Valve Insufficiency - diagnostic imaging Tricuspid Valve Insufficiency - surgery Ultrasonography Heart defects Atrioventricular valve repair Atrioventricular valve regurgitation Congenital Fontan operation Risk factors
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Summary:	OBJECTIVES The influence of concomitant atrioventricular valve regurgitation on the results of Fontan operation remains disputable. The goal of this study was to compare early and late results of Fontan operation performed in patients with mild or moderate-to-severe atrioventricular valve regurgitation. METHODS For retrospective analysis, patients with atrioventricular valve insufficiency assessed by echocardiography were divided into three groups based on the severity of regurgitation and its repair or non-repair during Fontan operation: Group 1: unrepaired regurgitation 1–2+ (n = 33); Group 2: unrepaired regurgitation 3–4+ (n = 11); Group 3: repaired regurgitation 3–4+ (n = 35). Actuarial survival was estimated by the Kaplan–Meier method, followed by the log-rank test to compare survival curves between groups. RESULTS Hospital mortality rates in Groups 1 through 3 reached 3, 27 and 14%, respectively (P = 0.015, Group 1 vs Group 2). The frequency of non-lethal complications did not significantly differ between groups. However, patients from Group 2 required significantly more intensive inotropic support, longer mechanical ventilation and had larger pleural effusion. Predicted survival after Fontan operation was the worst in Group 2 (P = 0.016, Group 2 vs Group 1). The frequency of non-lethal late complications was also the highest in Group 2 (50 vs 17 or 11%); however, the difference did not reach statistical significance (P = 0.13 and 0.069, respectively). The severity of atrioventricular valve regurgitation during the follow-up did not significantly change when compared with discharge after the repair in Group 2 or Group 3 (P = 0.19 and 0.52, respectively), and significantly increased in Group 1 (P = 0.003). However, this increase did not have clinical significance during the reported period of follow-up. CONCLUSIONS If unrepaired, concomitant moderate-to-severe atrioventricular valve regurgitation significantly worsens the results of the Fontan procedure. Longer observation is needed to define the strategy in patients with mild atrioventricular valve regurgitation that remained unrepaired during Fontan operation.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1010-7940 1873-734X
DOI:	10.1093/ejcts/ezu489