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Published on: February 11, 2022
Atrioventricular valve surgery in patients with univentricular heart and two separate atrioventricular valves
Benedikt Mayr1,2, Takuya Osawa3,4, Helena Staehler3,4
1Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany.
Insights
Surgical intervention for atrioventricular valves in patients with univentricular heart is needed for a minority but carries a high reoperation rate. Outcomes include low mortality but significant long-term reoperation incidence.
Area of Science:
- Congenital heart disease
- Pediatric cardiology
- Cardiac surgery
Background:
- Atrioventricular valve regurgitation is a known risk factor for poor outcomes in patients with univentricular heart.
- Repairing atrioventricular valves in these patients presents a significant surgical challenge.
Purpose of the Study:
- To evaluate the outcomes of surgical atrioventricular valve procedures in patients with univentricular heart and two separate atrioventricular valves.
- To determine reoperation-free survival and cumulative incidence of reoperation after these interventions.
Main Methods:
- A retrospective review of surgical atrioventricular valve procedures in patients with univentricular heart and two separate atrioventricular valves was conducted.
- Study endpoints included reoperation-free survival and cumulative incidence of reoperation.
Main Results:
- Between 1994 and 2021, 202 patients underwent surgical palliation, with 15.8% requiring atrioventricular valve surgery.
- Operative and late mortality rates were 3.1% and 9.7%, respectively.
- Ten-year reoperation-free survival was 62.3%, with a cumulative incidence of reoperation at 30.9%.
Conclusions:
- Surgical intervention on atrioventricular valves is necessary for a minority of patients with univentricular heart and two separate atrioventricular valves.
- While associated with low operative mortality, these procedures have a high incidence of reoperation.
- Long-term management requires careful consideration due to the high reoperation rates.
Objectives:
Atrioventricular valve regurgitation in patients with univentricular heart is a well-known risk factor for adverse outcomes and atrioventricular valve repair remains a particular surgical challenge.
Methods:
We reviewed all surgical atrioventricular valve procedures in patients with univentricular heart and two separate atrioventricular valves who underwent surgical palliation. Endpoints of the study were reoperation-free survival and cumulative incidence of reoperation.
Results:
Between 1994 and 2021, 202 patients with univentricular heart and two separate atrioventricular valve morphology underwent surgical palliation, with 15.8% (32/202) requiring atrioventricular valve surgery. Primary diagnoses were double inlet left ventricle (n = 14, 43.8%), double outlet right ventricle (n = 7, 21.9%), and congenitally corrected transposition of the great arteries (n = 7, 21.9%). Median weight at valve surgery was 10.6 kg (interquartile range, 7.9-18.9). Isolated left or right atrioventricular valve surgery was required in nine (28.1%) and 22 patients (68.8%), respectively. Concomitant left and right atrioventricular valve surgery was performed in one patient (3.1%). Closure of the left valve was conducted in four patients (12.5%) and closure of the right valve in three (9.4%). Operative and late mortality were 3.1% and 9.7%, respectively. Reoperation-free survival and cumulative incidence of reoperation at 10 years after surgery were 62.3% (standard error of the mean: 6.9) and 30.9% (standard error of the mean: 9.6), respectively.
Conclusions:
In patients with univentricular heart and two separate atrioventricular valves, surgical intervention on these valves is required in a minority of patients and is associated with low mortality but high incidence of reoperation.
