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Long-term follow-up of atrioventricular valve function in Fontan patients: effect of atrioventricular valve surgery

Thierry Bove1, Eva Grootjans1, Romanie Naessens1

  • 1Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|September 8, 2023
PubMed

Insights

Fontan survivors show encouraging long-term survival, with 12.4% needing atrioventricular valve surgery. However, progressive declines in valve and ventricular function over time warrant further investigation into heart failure therapies.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • The Fontan procedure is a palliative surgery for single-ventricle congenital heart defects.
  • Long-term outcomes in Fontan survivors are influenced by atrioventricular valve and ventricular function.
  • Understanding the relationship between these factors is crucial for optimizing patient management.

Purpose of the Study:

  • To evaluate the relationship between atrioventricular valve function and ventricular function in Fontan survivors.
  • To assess the impact of atrioventricular valve surgery on long-term outcomes.
  • To analyze transplant-free survival rates in this population.

Main Methods:

  • Analysis of transplant-free survival and need for atrioventricular valve surgery in single-ventricle patients post-Fontan completion.
  • Longitudinal echocardiographic assessment of long-term valve and ventricular function.
  • Evaluation of 113 patients with a median follow-up of 16.3 years.

Main Results:

  • 25-year transplant-free survival was 90.4% ± 5.8%.
  • Atrioventricular valve surgery was performed in 12.4% of patients.
  • Progressive time-related decline in both atrioventricular valve function (HR 1.112) and ventricular function (HR 1.141) was observed.

Conclusions:

  • Long-term transplant-free survival in a homogeneously treated Fontan population is encouraging.
  • While atrioventricular valve surgery can result in durable function, a slow, time-related decline in valve and ventricular function is a concern.
  • Further research into additional heart failure therapies is warranted for Fontan survivors.
Abstract

Keywords:
Atrioventricular valveFontan physiologyOutcomeValve surgery

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