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Published on: January 27, 2023
Systemic-to-pulmonary shunt and progression of atrioventricular valve regurgitation: A multicenter study identifying
Akira Yamaguchi1,2, Hideyuki Kato1, Kazushi Maruo3
1Division of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Objective:
To evaluate the progression of systemic atrioventricular valve regurgitation (sAVVR) after the insertion of a systemic-to-pulmonary artery (SP) shunt.
Methods:
This multicenter, retrospective study (2009-2024) enrolled patients undergoing primary SP shunt and divided them into biventricular (BiV) and univentricular (UniV) groups. The primary outcome was the change in sAVVR grade between preoperative and second-stage repair. Secondary outcomes included changes in systemic atrioventricular valve annulus diameter (sAVVD), systemic ventricular diastolic diameter (sVDd), and bilateral pulmonary artery (PA) sizes. Subgroup analyses were performed for UniV by the presence of common atrioventricular valve and ventricle morphology.
Results:
Eighty-six patients in the BiV group and 105 patients in the UniV were included. Progression of sAVVR in both cohorts was observed (P < .05). Moderate or severe sAVVR developed more in UniV (BiV: from 0% to 4.7% vs UniV: from 8.1% to 21.9%, P < .05) with more sAVV intervention (BiV 1.2% vs UniV 16.2%, P < .05). The BiV group showed increased sAVVD, sVDd, and PA sizes (P < .05). In UniV, sAVVD and PA sizes increased, but sVDd change was not significant (P = .058). Among UniV, preoperative mild or greater sAVVR was more common in patients with common atrioventricular valve ((72.7%) or a dominant right ventricle (70.7%). Multivariable logistic regression identified heterotaxy as a risk factor for sAVVR progression (odds ratio, 1.42; 95% CI, 1.20-1.69; P < .05), with greater sAVVD and sVDd enlargement in patients with heterotaxy.
Conclusions:
SP was associated with sAVVR progression in both BiV and UniV; however, clinically significant sAVVR was uncommon in BiV. Heterotaxy independently predicted sAVVR progression, likely due to greater AV valve and ventricular dilatation.
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