Atrioventricular Valve Failure in Fontan Palliation

Area of Science:

• Cardiology
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Atrioventricular valve failure, including moderate to severe regurgitation or valve operation, is a known risk factor for adverse outcomes in patients who have undergone Fontan palliation.
• Understanding the incidence and impact of atrioventricular valve failure is crucial for improving long-term results in this patient population.

Purpose of the Study:

• To determine the incidence of atrioventricular valve failure in patients undergoing Fontan palliation.
• To evaluate the clinical impact of atrioventricular valve failure on the outcomes of Fontan palliation.

Main Methods:

• A retrospective, longitudinal cohort study was performed.
• Data were extracted from a bi-national, population-based registry, including 1,199 patients with complete follow-up after Fontan palliation.
• Incidence and clinical impact were analyzed based on valve type and occurrence of valve failure.

Main Results:

• The cumulative incidence of atrioventricular valve failure by age 25 varied by valve type, ranging from 8% for single mitral valves to 56% for common atrioventricular valves.
• A total of 132 repairs and 15 replacements were performed.
• Patients with atrioventricular valve failure had a 2.43-fold increased risk of Fontan circulation failure compared to those without valve failure.

Conclusions:

• Atrioventricular valve failure is a frequent complication following Fontan palliation.
• The presence of atrioventricular valve failure significantly increases the likelihood of Fontan circulation failure, highlighting the need for vigilant monitoring and management.