Prognosis and risk factors for mild to moderate or moderate atrioventricular valve regurgitation after Fontan operation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PENG Yongxuan ¹ , LIU Xu ¹ , HONG Haifa ¹ , ZHANG Haibo ¹ , LIU Jinfen ¹ ,  LU Yanan ²

1. Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, Medical School of Shanghai Jiao Tong University, Shanghai, 200127, P.R.China;
2. Department of Pediatric Cardiothoracic Surgery, Xinhua Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, 200092, P.R.China;

Corresponding author：

LU Yanan, Email: luscmc@189.cn

Keywords：

Atroventricular valve regurgitation; Fontan operation; single ventricle; atrioventricular valve repair

DOI：

10.7507/1007-4848.202002104

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Objective To investigate the prognosis and risk factors of mild to moderate or moderate atrioventricular valve regurgitation (AVVR) after Fontan operation.Methods A total of 34 patients with mild to moderate or moderate AVVR who accepted Fontan operation and atrioventricular valve (AVV) repair between 2004 and 2018 in our center were selected as an AVV repair group. The patients in the same period were matched as a control group by the ratio of 1 : 1-2. Finally 99 patients were included into this study, including 64 males and 35 females, with an average age of 63.4±36.3 months and weight of 17.3±6.7 kg. Grades of AVVR decreased more than 1 was defined as significant improvement. Endpoints of the study were death, Fontan takedown, AVV replacement. Risk factors including Fontan procedures, AVV repair procedures, cardiac anatomy were analyzed.Results Patients were followed up for 1.5 (0.3-4.0) years. Overall mortality was 15.2%. Most (82.4%) of AVV repair group accepted single AVV repair procedure while partial annuloplasty was the most common (52.9%). With the extension of follow-up, the degree of AVVR in the whole group showed a gradually increasing trend (r=0.352, P=0.000). Mild to moderate AVVR improved spontaneously after Fontan operation, while moderate AVVR did not. AVV repair could improve the degree of AVVR after moderate regurgitation, without increasing the surgical mortality, and regurgitation significantly decreased in 8.8% patients. AVV repair was not effective for mild to moderate AVVR and would increase surgical mortality. Conclusion AVV function shows a gradual downward trend after Fontan operation. AVV repair is effective for moderate AVVR, does not increase mortality, but the degree of improvement is limited. AVV repair is not effective for mild to moderate AVVR and increases surgical mortality.

Citation： PENG Yongxuan, LIU Xu, HONG Haifa, ZHANG Haibo, LIU Jinfen, LU Yanan. Prognosis and risk factors for mild to moderate or moderate atrioventricular valve regurgitation after Fontan operation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(1): 54-59. doi: 10.7507/1007-4848.202002104 Copy

1.	King G, Ayer J, Celermajer D, et al. Atrioventricular valve failure in Fontan palliation. J Am Coll Cardiol, 2019, 73(7): 810-822.
2.	Margossian R, Zak V, Shillingford AJ, et al. The effect of the superior cavopulmonary anastomosis on ventricular remodeling in infants with single ventricle. J Am Soc Echocardiogr, 2017, 30(7): 699-707.
3.	Misumi Y, Hoashi T, Kagisaki K, et al. Long-term outcomes of common atrioventricular valve plasty in patients with functional single ventricle. Interact Cardiovasc Thorac Surg, 2014, 18(3): 259-265.
4.	Naito Y, Hiramatsu T, Kurosawa H, et al. Long-term results of modified Fontan operation for single-ventricle patients associated with atrioventricular valve regurgitation. Ann Thorac Surg, 2013, 96(1): 211-218.
5.	Laux D, Vergnat M, Lambert V, et al. Atrio-ventricular valve regurgitation in univentricular hearts: outcomes after repair? Interact Cardiovasc Thorac Surg, 2015, 20(5): 622-629.
6.	Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr, 2003, 16(7): 777-802.
7.	Mahle WT, Cohen MS, Spray TL, et al. Atrioventricular valve regurgitation in patients with single ventricle: impact of the bidirectional cavopulmonary anastomosis. Ann Thorac Surg, 2001, 72(3): 831-835.
8.	Yamagishi S, Masuoka A, Uno Y, et al. Influence of bidirectional cavopulmonary anastomosis and concomitant valve repair on atrioventricular valve annulus and function. Ann Thorac Surg, 2014, 98(2): 641-647.
9.	Grosse-Wortmann L, Al-Otay A, Yoo SJ. Aortopulmonary collaterals after bidirectional cavopulmonary connection or Fontan completion: quantification with MRI. Circ Cardiovasc Imaging, 2009, 2(3): 219-225.
10.	Stephens EH, Dearani JA. Management of the bad atrioventricular valve in Fontan…time for a change. J Thorac Cardiovasc Surg, 2019, 158(6): 1643-1648.
11.	Gil-Jaurena JM, González-López MT, Pérez-Caballero R, et al. Atrioventricular valve repair along with Fontan completion. Cardiol Young, 2015, 25(7): 1421-1424.
12.	Honjo O, Atlin CR, Mertens L, et al. Atrioventricular valve repair in patients with functional single-ventricle physiology: impact of ventricular and valve function and morphology on survival and reintervention. J Thorac Cardiovasc Surg, 2011, 142(2): 326-335.
13.	Shaikhrezai K, McLeod K, Knight B, et al. Two-strip technique to repair common atrioventricular valve regurgitation in single-ventricle palliation. Ann Thorac Surg, 2015, 100(3): 1124-1125.
14.	Sughimoto K, Konstantinov IE, Brizard CP, et al. Polytetrafluoroethylene bridge for atrioventricular valve repair in single-ventricle palliation. J Thorac Cardiovasc Surg, 2015, 149(2): 641-643.

1. King G, Ayer J, Celermajer D, et al. Atrioventricular valve failure in Fontan palliation. J Am Coll Cardiol, 2019, 73(7): 810-822.
2. Margossian R, Zak V, Shillingford AJ, et al. The effect of the superior cavopulmonary anastomosis on ventricular remodeling in infants with single ventricle. J Am Soc Echocardiogr, 2017, 30(7): 699-707.
3. Misumi Y, Hoashi T, Kagisaki K, et al. Long-term outcomes of common atrioventricular valve plasty in patients with functional single ventricle. Interact Cardiovasc Thorac Surg, 2014, 18(3): 259-265.
4. Naito Y, Hiramatsu T, Kurosawa H, et al. Long-term results of modified Fontan operation for single-ventricle patients associated with atrioventricular valve regurgitation. Ann Thorac Surg, 2013, 96(1): 211-218.
5. Laux D, Vergnat M, Lambert V, et al. Atrio-ventricular valve regurgitation in univentricular hearts: outcomes after repair? Interact Cardiovasc Thorac Surg, 2015, 20(5): 622-629.
6. Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr, 2003, 16(7): 777-802.
7. Mahle WT, Cohen MS, Spray TL, et al. Atrioventricular valve regurgitation in patients with single ventricle: impact of the bidirectional cavopulmonary anastomosis. Ann Thorac Surg, 2001, 72(3): 831-835.
8. Yamagishi S, Masuoka A, Uno Y, et al. Influence of bidirectional cavopulmonary anastomosis and concomitant valve repair on atrioventricular valve annulus and function. Ann Thorac Surg, 2014, 98(2): 641-647.
9. Grosse-Wortmann L, Al-Otay A, Yoo SJ. Aortopulmonary collaterals after bidirectional cavopulmonary connection or Fontan completion: quantification with MRI. Circ Cardiovasc Imaging, 2009, 2(3): 219-225.
10. Stephens EH, Dearani JA. Management of the bad atrioventricular valve in Fontan…time for a change. J Thorac Cardiovasc Surg, 2019, 158(6): 1643-1648.
11. Gil-Jaurena JM, González-López MT, Pérez-Caballero R, et al. Atrioventricular valve repair along with Fontan completion. Cardiol Young, 2015, 25(7): 1421-1424.
12. Honjo O, Atlin CR, Mertens L, et al. Atrioventricular valve repair in patients with functional single-ventricle physiology: impact of ventricular and valve function and morphology on survival and reintervention. J Thorac Cardiovasc Surg, 2011, 142(2): 326-335.
13. Shaikhrezai K, McLeod K, Knight B, et al. Two-strip technique to repair common atrioventricular valve regurgitation in single-ventricle palliation. Ann Thorac Surg, 2015, 100(3): 1124-1125.
14. Sughimoto K, Konstantinov IE, Brizard CP, et al. Polytetrafluoroethylene bridge for atrioventricular valve repair in single-ventricle palliation. J Thorac Cardiovasc Surg, 2015, 149(2): 641-643.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Prognosis and risk factors for mild to moderate or moderate atrioventricular valve regurgitation after Fontan operation

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