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Long-term outcomes of common atrioventricular valve plasty in patients with functional single ventricle

Yusuke Misumi1, Takaya Hoashi, Koji Kagisaki

  • 1Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.

Interactive Cardiovascular and Thoracic Surgery
|December 17, 2013
PubMed

Insights

Common atrioventricular valve regurgitation is a risk factor for mortality in single ventricle patients. Surgical repair (CAVV plasty) offers improved survival, though reoperation may be necessary.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Common atrioventricular valve regurgitation (CAVV) is a significant risk factor for mortality and Fontan completion in patients with functional single ventricle.
  • Effective management of CAVV regurgitation is crucial for improving outcomes in this complex patient population.

Purpose of the Study:

  • To review the surgical experience with common atrioventricular valve plasty (CAVV plasty) in candidates for the Fontan operation.
  • To evaluate the long-term outcomes, survival rates, and need for valve replacement after CAVV plasty.

Main Methods:

  • A review of 38 consecutive Fontan candidates who underwent CAVV plasty between 1995 and the present.
  • The modified Alfieri technique using a polytetrafluoroethylene (PTFE) bridging strip was the primary repair method used.
  • Follow-up data were collected for a mean of 7.1 years, assessing survival and freedom from CAVV replacement.

Main Results:

  • Actuarial survival rates at 1, 5, and 10 years were 81%, 70%, and 67%, respectively.
  • Freedom from CAVV replacement rates at 1, 5, and 10 years were 89%, 85%, and 75%, respectively.
  • Twenty-three patients (61%) completed the Fontan operation; mortality was associated with total anomalous pulmonary venous connection and CAVV plasty performed before bidirectional Glenn (BDG).

Conclusions:

  • CAVV plasty remains a challenging procedure in functional single ventricle patients, but aggressive surgical intervention can improve long-term prognosis.
  • The ventricular unloading effect of BDG alone did not consistently maintain CAVV function, suggesting that CAVV replacement should be considered for severe regurgitation.
  • While the modified Alfieri technique showed promise, further follow-up is needed to confirm its long-term therapeutic superiority.
Abstract

Keywords:
Atrioventricular valve plastyCommon atrioventricular valveFontanSingle ventricle

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