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Results of Fontan operation in patients with atrioventricular valve regurgitation

Vladimir P Podzolkov1, Mikhail R Chiaureli1, Ivan A Yurlov1

  • 1Bakoulev Center for Cardiovascular Surgery, Moscow, Russia.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|December 21, 2014
PubMed

Insights

Unrepaired moderate-to-severe atrioventricular valve regurgitation significantly worsens outcomes after the Fontan operation. Further study is needed for mild regurgitation management strategies.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • The impact of atrioventricular valve regurgitation on Fontan operation results is debated.
  • Evaluating the influence of regurgitation severity and repair status is crucial for patient outcomes.

Purpose of the Study:

  • To compare early and late outcomes of the Fontan operation in patients with mild or moderate-to-severe atrioventricular valve regurgitation.
  • To assess the effect of surgical repair of atrioventricular valve regurgitation during the Fontan procedure.

Main Methods:

  • Retrospective analysis of patients undergoing Fontan operation.
  • Classification into three groups: unrepaired mild (1-2+), unrepaired severe (3-4+), and repaired severe (3-4+) regurgitation.
  • Kaplan-Meier survival analysis and log-rank testing for comparative outcomes.

Main Results:

  • Hospital mortality was significantly higher in unrepaired severe regurgitation (27%) compared to mild (3%).
  • Unrepaired severe regurgitation was associated with worse predicted survival and increased need for intensive support and longer ventilation.
  • Late complication rates were highest in the unrepaired severe regurgitation group, though not statistically significant.

Conclusions:

  • Moderate-to-severe atrioventricular valve regurgitation, if unrepaired, significantly deteriorates Fontan operation results.
  • The optimal strategy for mild atrioventricular valve regurgitation during Fontan operation requires longer follow-up and further investigation.
Abstract

Keywords:
Atrioventricular valve regurgitationAtrioventricular valve repairCongenitalFontan operationHeart defectsRisk factors

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