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Atrioventricular valve replacement in patients with a single ventricle
W T Mahle1, J W Gaynor, T L Spray
1Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 19104, USA. mahle@email.chop.edu
The Annals of Thoracic Surgery
|July 24, 2001
Summary
Atrioventricular valve (AVV) replacement in single ventricle patients is feasible with acceptable outcomes. Postoperative heart block is common, but survival has improved, suggesting earlier intervention may further enhance results.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Congenital Heart Disease
Background:
- Significant atrioventricular valve (AVV) insufficiency poses risks in single ventricle patients.
- While valvuloplasty is common, AVV replacement is sometimes necessary.
- Optimal timing, outcomes, and risk factors for AVV replacement in this population remain unclear.
Purpose of the Study:
- To evaluate the outcomes of atrioventricular valve replacement in patients with single ventricle.
- To identify risk factors associated with mortality and complications after AVV replacement.
Main Methods:
- Retrospective review of 17 single ventricle patients undergoing AVV replacement between 1984 and 2000.
- Analysis of outcome variables including mortality and valve-related complications.
Main Results:
- Hospital mortality was 29%, significantly decreasing over time (56% vs. 0%, p=0.03).
- Younger age (<2 years) was a risk factor for hospital mortality (p=0.03).
- 44% developed complete heart block postoperatively; no cerebrovascular accidents occurred.
Conclusions:
- Atrioventricular valve replacement is a viable option for single ventricle patients, with improving survival rates.
- Postoperative complete heart block is a frequent complication.
- Early intervention before ventricular dysfunction may improve long-term outcomes.