Results of Fontan operation in patients with atrioventricular valve regurgitation

• 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
• DOI: 10.1093/ejcts/ezu489
• EISSN: 1873-734X
• ISSN: 1010-7940

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.