Long-term outcomes of common atrioventricular valve replacement for patients with functional single ventricle

This study compared the long-term outcomes of common atrioventricular valve replacement after common atrioventricular valve plasty and common atrioventricular valve plasty alone in patients with a functional single ventricle.

We retrospectively evaluated 30 patients with functional single ventricle who experienced controlled common atrioventricular valve regurgitation with repeated common atrioventricular valve plasty alone (group R(-)) and 19 patients with functional single ventricle who experienced controlled common atrioventricular valve regurgitation with common atrioventricular valve replacement (group R(+)) at our institution. All patients underwent common atrioventricular valve plasty. We evaluated the survival and cumulative incidence of Fontan completion after the initial common atrioventricular valve plasty and hemodynamic parameters after Fontan completion in both groups.

The cumulative incidence of common atrioventricular valve replacement was 35% at 10 years after the initial common atrioventricular valve plasty. Multivariable competing risk regression analysis identified 2 factors associated with common atrioventricular valve replacement: The initial common atrioventricular valve plasty was performed before the bidirectional Glenn procedure (hazard ratio, 3.13; 95% CI, 1.19-8.19; P = .020) and severe common atrioventricular valve regurgitation at the initial common atrioventricular valve plasty (hazard ratio, 2.84; 95% CI, 1.07-7.59; P = .037). The 10-year survivals of the R(-) (73%) and R(+) (78%) groups were not significantly different. Groups R(-) and R(+) had comparable Fontan completion rates (73% vs 66%) after 3 years. The Fontan pressure, ventricular end-diastolic pressure, and cardiac index were comparable between groups R(-) and R(+) (10 mm Hg vs 10 mm Hg [P = .27], 8 mm Hg vs 7 mm Hg [P = .97], and 2.9 L/min/m² vs 3.1 L/min/m² [P = .60], respectively).

Common atrioventricular valve replacement may be a reasonable option for treating uncontrolled common atrioventricular valve regurgitation in patients with a functional single ventricle.