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Long-term outcome after atrioventricular valve surgery following modified Fontan operation

Shaji C Menon1, Joseph A Dearani, Frank Cetta

  • 1Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA. shaji.menon@utah.edu

Cardiology in the Young
|October 28, 2010
PubMed

Insights

Atrioventricular valve surgery after the Fontan procedure has substantial late risks, including high mortality and protein-losing enteropathy. Reduced ventricular function and protein-losing enteropathy significantly decrease survival rates in these patients.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease Management

Background:

  • Atrioventricular valve regurgitation is a known risk factor for Fontan operation.
  • Limited data exist on the long-term outcomes of atrioventricular valve surgery following Fontan procedure.

Purpose of the Study:

  • To evaluate the early and late results of atrioventricular valve surgery performed after a Fontan operation.

Main Methods:

  • Retrospective review of 61 patients who underwent atrioventricular valve surgery post-Fontan from the Mayo Clinic Fontan database.
  • Analysis of pre-operative, operative, and post-operative clinical and hemodynamic data.
  • Health status questionnaires sent to assess long-term outcomes.

Main Results:

  • 52% mortality rate, with 13% within 30 days; 15-year survival was 45%.
  • High incidence of post-operative complications: 72% developed arrhythmias, 20% developed protein-losing enteropathy.
  • Reduced ventricular function and protein-losing enteropathy were linked to decreased survival on multivariate analysis.

Conclusions:

  • Atrioventricular valve surgery post-Fontan is associated with significant late morbidity and mortality.
  • This cohort experienced poor long-term outcomes and a high rate of protein-losing enteropathy.
  • Reduced ventricular function and protein-losing enteropathy are critical factors impacting survival.
Abstract

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