Atrioventricular valve repair along with Fontan completion

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.