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Long-term results of modified Fontan operation for single-ventricle patients associated with atrioventricular valve

Yuji Naito1, Takeshi Hiramatsu, Hiromi Kurosawa

  • 1Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan. ujinaito@gmail.com

The Annals of Thoracic Surgery
|April 30, 2013
PubMed

Insights

Modified Fontan operations with atrioventricular valve (AVV) plasty had lower survival rates than those without AVV plasty. Early intervention for AVV pathology may improve outcomes, with circular annuloplasty being a reliable repair option.

Area of Science:

  • Pediatric Cardiac Surgery
  • Congenital Heart Disease Management
  • Valvular Heart Disease Treatment

Background:

  • Long-term outcomes of modified Fontan operation combined with atrioventricular valve (AVV) regurgitation repair are not well-documented.
  • Atrioventricular valve regurgitation is a common complication following Fontan procedures.

Purpose of the Study:

  • To evaluate the long-term outcomes of modified Fontan operations with and without concomitant atrioventricular valve (AVV) plasty.
  • To identify factors influencing patient survival after modified Fontan operation.

Main Methods:

  • Retrospective analysis of 500 children undergoing modified Fontan operation between 1977 and 2003.
  • Patients were divided into two groups: 192 with AVV plasty (group P) and 308 without AVV plasty (group N).
  • Surgical techniques for AVV repair included circular annuloplasty, partial annuloplasty, edge-to-edge repair, and valvoplasty.

Main Results:

  • Actuarial survival rates at 10 and 20 years were lower in group P (82.0%, 76.6%) compared to group N (90.8%, 86.8%).
  • No significant difference in 10-year survival was observed among different AVV plasty techniques.
  • Higher preoperative ventricular ejection fraction was associated with reduced long-term mortality in group P.

Conclusions:

  • Modified Fontan operations with AVV plasty are associated with worse long-term survival compared to those without AVV intervention.
  • Early intervention for AVV pathology before ventricular dysfunction may improve outcomes.
  • Circular annuloplasty is a technically simple and reliable repair option for AVV lesions.
Abstract

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