Systemic Atrioventricular Valve Replacement in Patients With Functional Single Ventricle

Nakata, Tomohiro; Hoashi, Takaya; Shimada, Masatoshi; Ozawa, Hideto; Higashida, Akihiko; Kurosaki, Kenichi; Ichikawa, Hajime

doi:10.1053/j.semtcvs.2019.05.019

Cited by 12 publications

(5 citation statements)

References 25 publications

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“…There is an epidemic of patients with atrioventricular valve regurgitation. Interestingly, this work, like others, points to the fact that replacement of these valves may be a viable option in this population [ 5 , 6 ].…”

supporting

confidence: 57%

The Fontan procedure is no longer the last operation

Venna

d’Udekem

2022

Interactive CardioVascular and Thoracic Surgery

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supporting

confidence: 57%

The Fontan procedure is no longer the last operation

Venna

d’Udekem

2022

Interactive CardioVascular and Thoracic Surgery

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“…Valve replacement in patients with single ventricle does not have a favorable prognosis, although it could be the last option. [16][17][18][19] In our study, a valve replacement was performed in only 2 patients as a first procedure, and both patients died at follow-up. A valve replacement was performed in 3 patients as AVV reoperation.…”

Section: Discussionmentioning

confidence: 80%

Long-term outcomes of atrioventricular septal defect and single ventricle: A multicenter study

Arrigoni

IJsselhof

Postmus

et al. 2022

The Journal of Thoracic and Cardiovascular Surgery

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Objective:The study objective was to analyze survival and incidence of Fontan completion of patients with single-ventricle and concomitant unbalanced atrioventricular septal defect.Methods: Data from 4 Dutch and 3 Belgian institutional databases were retrospectively collected. A total of 151 patients with single-ventricle atrioventricular septal defect were selected; 36 patients underwent an atrioventricular valve procedure (valve surgery group). End points were survival, incidence of Fontan completion, and freedom from atrioventricular valve reoperation.Results: Median follow-up was 13.4 years. Cumulative survival was 71.2%, 70%, and 68.5% at 10, 15, and 20 years, respectively. An atrioventricular valve procedure was not a risk factor for mortality. Patients with moderate-severe or severe atrioventricular valve regurgitation at echocardiographic follow-up had a significantly worse 15year survival (58.3%) compared with patients with no or mild regurgitation (89.2%) and patients with moderate regurgitation (88.6%) (P ¼ .033). Cumulative incidence of Fontan completion was 56.5%, 71%, and 77.6% at 5, 10, and 15 years, respectively. An atrioventricular valve procedure was not associated with the incidence of Fontan completion. In the valve surgery group, freedom from atrioventricular valve reoperation was 85.7% at 1 year and 52.6% at 5 years. Conclusions:The long-term survival and incidence of Fontan completion in our study were better than previously described for patients with single-ventricle atrioventricular septal defect. A concomitant atrioventricular valve procedure did not increase the mortality rate or decrease the incidence of Fontan completion, whereas patients with moderate-severe or severe valve regurgitation at follow-up had a worse survival. Therefore, in patients with single-ventricle atrioventricular septal defect when atrioventricular valve regurgitation exceeds a moderate degree, the atrioventricular valve should be repaired.

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“…Among 9 patients undergoing AV valve or semilunar valve replacement, 8 patients survived during the median follow-up of 7.1 (0.1–15.7) years. The reason for the improved survival of valve replacement after Fontan completion compared to previous reports with 45–60% late mortality was unclear [ 12 , 17 ]. However, we assume that it is multifactorial, and operative timing can be the most important factor.…”

Section: Discussionmentioning

confidence: 96%

Surgical outcomes of reoperation after Fontan completion

Nakayama

Shinkawa

Hoki

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES Patients who have achieved Fontan circulation may require reoperation. We reviewed the outcomes of reoperation after Fontan completion and assessed the risk factors for poor outcomes. METHODS This was a retrospective study of 106 patients undergoing open-heart reoperations after Fontan completion in 2003 at a single institution. RESULTS The mean age at reoperation was 24.6 ± 8.3 years. A history of Fontan failure or end-organ dysfunction was noted in 30 patients. The reoperations included 73 total cavopulmonary connection conversions, 29 atrioventricular or semilunar valve operations (17 with total cavopulmonary connection conversions) and 4 other operations. Eight early deaths occurred. During a median follow-up of 5.5 (0.01–16.2) years, there were 3 late deaths and 9 second cardiac operations. The 10-year survival rate after reoperation was 89.8%, and the 5-year second cardiac operation-free survival was 84.3%. The 10-year survival rates were significantly lower in patients who underwent surgery before 2011 (75.8% vs 100%), had a history of Fontan failure or end-organ dysfunction (71.7% vs 97.3%), had preoperative central venous pressure >15 mmHg (64.9% vs 96.5%) and were operated on with deep hypothermic circulatory arrest (DHCA) (60.0% vs 91.3%). A history of Fontan failure or end-organ dysfunction, preoperative central venous pressure >15 mmHg and requirement of DHCA were identified as risk factors for mortality. CONCLUSIONS Reoperation after Fontan completion resulted in excellent mid-term outcomes. A history of failed Fontan circulation and the requirement of DHCA negatively affected survival outcomes.

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Systemic Atrioventricular Valve Replacement in Patients With Functional Single Ventricle

Cited by 12 publications

References 25 publications

The Fontan procedure is no longer the last operation

The Fontan procedure is no longer the last operation

Long-term outcomes of atrioventricular septal defect and single ventricle: A multicenter study

Surgical outcomes of reoperation after Fontan completion

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