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Atrioventricular valve repair along with Fontan completion
Juan M Gil-Jaurena1, María T González-López1, Ramón Pérez-Caballero1
1Pediatric Cardiac Surgery,Hospital General Universitario Gregorio Marañón,Madrid,Spain.
Insights
Atrioventricular valve repair is a low-risk procedure for Fontan completion patients with moderate to severe regurgitation. Simple surgical techniques improve long-term outcomes for these complex cases.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
Background:
- Atrioventricular valve regurgitation is a known risk factor for Fontan completion in patients with univentricular physiology.
- Current indications and timing for atrioventricular valve repair are not well-defined, with varied surgical techniques proposed.
Observation:
- Fifty consecutive patients underwent extracardiac Fontan completion since 2013.
- Atrioventricular valve repair was performed concomitantly in three patients, avoiding prosthetic rings, with excellent short-term results.
- Beating-heart repair was successfully used in one patient with hypoplastic left heart syndrome.
Findings:
- Atrioventricular valve repair in the presence of moderate or severe regurgitation can be performed with low risk.
- Both staged and combined approaches to atrioventricular valve repair and Fontan completion are viable management strategies.
- Simple, "easy and simple" surgical techniques for atrioventricular valve repair are crucial.
Implications:
- Atrioventricular valve repair, particularly with simpler techniques, can improve the long-term prognosis for Fontan patients.
- Further research into optimal timing and techniques for atrioventricular valve repair in Fontan candidates is warranted.
- These findings support the consideration of concomitant atrioventricular valve repair during Fontan procedures.
Abstract:
Atrioventricular valve regurgitation is widely known as a risk factor for Fontan completion in patients with univentricular physiology. To date, indications and timing for atrioventricular valve repair remain unclear and different surgical techniques have been advocated. Since 2013, 50 consecutive patients underwent extracardiac Fontan completion in our institution. Atrioventricular valve repair, by avoiding the use of a prosthetic ring, was performed as a concomitant procedure in three of them, with excellent short-term results. Beating-heart repair was performed in one of the patients with hypoplastic left heart syndrome as the underlying disease. Valve repair when moderate or severe regurgitation is present may be performed at a low risk. Both the staged approach of atrioventricular valve repair followed by the Fontan as a separate operation and the combined approach of simultaneous atrioventricular valve repair and Fontan have a role in the management of these complex patients. We highlight the importance of the use of "easy and simple" surgical techniques for repairing the atrioventricular valve in order to provide a better life prognosis in Fontan patients.
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