Results of Left Atrioventricular Valve Reoperations Following Previous Repair of Atrioventricular Septal Defects

Abstract

LAVVR results in significant clinical improvement and lasting recovery in ventricular chamber function and size. Valve repair offers survival advantage and should be aggressively attempted; however, it is only achievable in 50% of cases. Valve replacement is necessary in cases associated with complex LAVV morphology or following repair failure. At intermediate follow-up, patients continue to be at risk of major valve-related morbidity, requirement for re-intervention, and cardiac death.

Reoperation for left atrioventricular valve failure in repaired atrioventricular septal defect: Can more valves be preserved in the current era?

“…Moreover, a higher proportion of patients in the LAVVR group underwent re‐operation compared to the LAVVRep air group (42% vs 11%). Similar findings related to mechanical mitral prostheses in children have been reported and are particularly relevant in young children who have a lifetime exposure to the risks of the prosthesis, including the need for repeat valve replacement due to somatic outgrowth of the prosthesis …”

“…At the time of redo‐surgery, LAVV repair techniques are normally considered preferable to replacement due preservation of the sub‐valvar apparatus, improved long‐term left ventricular function, and potential for growth . Moreover, the need for permanent anticoagulation and higher incidence of pacemaker (PM) implant associated with mechanical LAVV replacement are known to contribute to poor outcomes …”

“…Results of atrio-ventricular septal defect (AVSD) repair in the current era have proved to be excellent in the short and long term 1-3 but postoperative left atrio-ventricular valve (LAVV) regurgitation can still be a significant problem and is estimated to occur in up to 18% of patients. [4][5][6][7][8][9] Risk factors for LAVV regurgitation such as presence of dysplastic, double orifice, or parachute LAVV have been identified, 6,[10][11][12][13][14][15] as have strategies to reduce the risk, including early primary repair, routine cleft closure, and annular stabilization. 2,[10][11][12][16][17][18][19] Nonetheless, LAVV regurgitation remains the main reason for reoperation after AVSD repair.…”

“…4,[7][8][9][10][11][12][13] At the time of redo-surgery, LAVV repair techniques are normally considered preferable to replacement due preservation of the subvalvar apparatus, improved long-term left ventricular function, and potential for growth. 10,13,14,17 Moreover, the need for permanent anticoagulation and higher incidence of pacemaker (PM) implant associated with mechanical LAVV replacement are known to contribute to poor outcomes. 20,21 The objective of our study was to review our experience with preservation of the LAVV at the time of redo surgery and how this has changed over time.…”

Outcomes and associated risk factors for mitral valve replacement in children☆

“…However, mitral valve replacement (MVR) may be required in a subset of children for whom the mitral valve cannot be repaired or following repair failure [4][5][6][7][8][9][10][11].…”