Atrio-ventricular valve regurgitation in univentricular hearts: outcomes after repair

Laux, Daniéla; Vergnat, Mathieu; Lambert, Virginie; Gouton, Marielle; Ly, Mohamed; Peyre, Marianne; Roussin, Régine; Belli, Emrè

doi:10.1093/icvts/ivv011

Cited by 7 publications

(9 citation statements)

References 23 publications

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“…1,2,4 Nevertheless, until now, AVV regurgitation is an independent risk factor in this population. 1,2,5,6 Regurgitation mechanisms depend on many factors and are generally complicated and multifactorial. 2,7,8 It is well-known that chronical volume overload causes annular dilatation.…”

Section: Introductionmentioning

confidence: 90%

“…Atrioventricular valve (AVV) regurgitation used to be a contraindication in Fontan candidates. [1][2][3] Advances in myocardial protection and valve repair techniques allowed concomitant staged single ventricle (SV) palliation and AVV repair. 1,2,4 Nevertheless, until now, AVV regurgitation is an independent risk factor in this population.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Advances in myocardial protection and valve repair techniques allowed concomitant staged single ventricle (SV) palliation and AVV repair. 1,2,4 Nevertheless, until now, AVV regurgitation is an independent risk factor in this population. 1,2,5,6 Regurgitation mechanisms depend on many factors and are generally complicated and multifactorial.…”

Section: Introductionmentioning

confidence: 99%

“…2,7,8 It is well-known that chronical volume overload causes annular dilatation. 1,9 On the other hand, in the majority of cases, there is a combination of annular dilatation and some structural abnormality contributing to regurgitation. 2,5,[7][8][9][10] Cavopulmonary connection promotes SV unloading, and it is known that this leads to ventricular and atrioventricular annulus remodeling.…”

Section: Introductionmentioning

confidence: 99%

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Atrioventricular Valve Repair in Single Ventricle Physiology: Timing Matters

Miana

Manuel

Turquetto

et al. 2019

World J Pediatr Congenit Heart Surg

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Objectives: Atrioventricular valve (AVV) regurgitation in patients with single ventricle (SV) physiology severely impacts prognosis; the appropriate timing for surgical treatment is unknown. We sought to study the results of surgical treatment of AVV regurgitation in SV patients and evaluate risk factors for mortality. Methods: Medical records of 81 consecutive patients with moderate or severe AAV regurgitation who were submitted to AVV repair or replacement during any stage of univentricular palliation between January 2013 and May 2017 were examined. We studied demographic data and perioperative factors looking for predictors that might have influenced the results. Binary logistic regression was used to assess the impact on postoperative ventricular dysfunction and mortality. Results: Median age and weight were seven months (interquartile range [IQR]: 3-24) and 5.2 kg (IQR: 3.7-11.2), respectively. Seventy (86.4%) patients underwent AVV repair, and 11 (13.6%) patients underwent AVV replacement. There was an association between AVV repair effectiveness and timing of intervention ( P = .004). Atrioventricular valve intervention at the time of initial surgical palliation was associated with more ineffective repairs ( P = .001), while AVV replacement was more common between Glenn and Fontan procedures ( P = .004). Overall 30-day mortality was 30.5% (25 patients). In-hospital mortality was 49.4%, and it was higher when AVV repair was performed concomitant with initial (stage 1) palliation (64.1% vs 35.7%; P = .01) and when an effective repair was not achieved (75% vs 41%; P = .008). Multivariable analysis identified timing concomitant with stage 1 palliation as an independent risk factor for mortality ( P = .01); meanwhile, an effective repair was a protective factor against in-hospital mortality ( P = .05). Conclusion: Univentricular physiology with AVV regurgitation is a high-risk group of patients. Surgery for AVV regurgitation at stage 1 palliation was associated with less effective repair and higher mortality in this initial experience. On the other hand, effective repair determined better outcomes, highlighting the importance of experience and the learning curve in the management of such patients.

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Section: Introductionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Atrioventricular Valve Repair in Single Ventricle Physiology: Timing Matters

Miana

Manuel

Turquetto

et al. 2019

World J Pediatr Congenit Heart Surg

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“…There is conflicting evidence on the benefits of early atrioventricular valve repair or replacement. [36][37][38] Multivariable competing risk analysis through 5 years of follow-up demonstrates that greater than mild AVVR, prolonged hospitalization after Stage 1 palliation, and age <3 months at time of SCPC are independent risk factors for death or transplant. Concomitantly, greater than mild AVVR and age <3 months are independently associated with an overall decreased rate of Fontan completion.…”

Section: Causes Of Failure To Progress Along the Single Ventricle Patmentioning

confidence: 99%

Superior Cavopulmonary Connection: Its Physiology, Limitations, and Anesthetic Implications

Choi

DiNardo

Brown

2020

Semin Cardiothorac Vasc Anesth

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The superior cavopulmonary connection (SCPC) or “bidirectional Glenn” is an integral, intermediate stage in palliation of single ventricle patients to the Fontan procedure. The procedure, normally performed at 3 to 6 months of life, increases effective pulmonary blood flow and reduces the ventricular volume load in patients with single ventricle (parallel circulation) physiology. While the SCPC, with or without additional sources of pulmonary blood flow, cannot be considered a long-term palliation strategy, there are a subset of patients who require SCPC palliation for a longer interval than the typical patient. In this article, we will review the physiology of SCPC, the consequences of prolonged SCPC palliation, and modes of failure. We will also discuss strategies to augment pulmonary blood flow in the presence of an SCPC. The anesthetic considerations in SCPC patients will also be discussed, as these patients may present for noncardiac surgery from infancy to adulthood.

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Outcome and performance of bioprosthetic pulmonary valve replacement in patients with congenital heart disease

Nomoto

Sleeper

Borisuk

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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Atrio-ventricular valve regurgitation in univentricular hearts: outcomes after repair

Abstract: In patients with a UVH and ≥ moderate AVV regurgitation, AVV repair is feasible without postoperative deterioration of their ventricular function. Nevertheless, these patients remain at increased risk for death/transplantation and AVV reoperation.

Cited by 7 publications

References 23 publications

Atrioventricular Valve Repair in Single Ventricle Physiology: Timing Matters

Atrioventricular Valve Repair in Single Ventricle Physiology: Timing Matters

Superior Cavopulmonary Connection: Its Physiology, Limitations, and Anesthetic Implications

Outcome and performance of bioprosthetic pulmonary valve replacement in patients with congenital heart disease

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