Repair of atrioventricular valve regurgitation in the modified Fontan operation

To evaluate the prevalence, impact and outcome of repair of atrioventricular valve regurgitation (AVVR) in Fontan patients.

We retrospectively reviewed 340 Fontan patients from 1986 to 2001. Twelve patients with valve closure or replacements were excluded. AVVR was graded by transthoracic echocardiography. Patients were divided into group O (no AVVR), group A (1+ to 2+) and group B (3+ to 4+).

AVVR was present in 129 (39.3%) patients. Repair was carried out in 37 (11.3%) with no difference in mortality as compared to no repair (18.9 vs 10.9%, P =0.16). Mean follow-up was 44 months (1-197 months) with 14 patients lost to follow-up. No valve repair was carried out in group O (192 patients) and no clinical change in AVVR was observed (pre-op 0.00, post-op 0.78). In group A (85 patients) 6 patients had valve repair without significant change in the degree of AVVR after valve repair (pre-op 1.8, post-op 2.2, P = 0.18). In group B (44 patients) 31 had valve repair and a significant reduction was observed (pre-op 3.28, post-op 2.44, P < 0.001). A similar improvement was also observed when the valve was not repaired (pre-op 3.25, post-op 2.44, P = 0.003). Survival at 10 years was comparable (83% repaired, 89% not repaired, P = 0.165). There was no difference in the incidence of long-term complications (26% repaired, 29.7% no repair, P = 0.64).

Trivial to mild AVVR remains stable and their repair during the Fontan operation provides no additional benefits. Valve repair in patients with moderate to severe AVVR improved the regurgitation with comparable operative mortality and long-term outcome; however, similar benefits could be achieved without repair of the atrioventricular valve. We should not deny patients with similar AVVR the Fontan operation.