Tags

Type your tag names separated by a space and hit enter

Perioperative risks and outcomes of atrioventricular valve surgery in conjunction with Fontan procedure.
Ann Thorac Surg. 2009 May; 87(5):1484-8; discussion 1488-9.AT

Abstract

BACKGROUND

Long-term outcomes of staged single-ventricle palliation can be impaired by atrioventricular valve (AVV) regurgitation. Atrioventricular valve repair or replacement has been shown to improve late outcomes, but little data exist regarding the associated perioperative morbidity. This study aimed to evaluate the additional perioperative risks associated with single-ventricle AVV surgery.

METHODS

Two hundred thirty-six consecutive Fontan procedures were retrospectively reviewed. Group 1 (n = 21, with concomitant AVV repair [n = 19] or replacement [n = 2]) was compared with group 2 (n = 215, no AVV surgery) with regard to preoperative characteristics and perioperative outcomes. Atrioventricular valve regurgitation was graded as 1 (none or trivial) to 4 (severe).

RESULTS

Group 1 patients were older (4.3 +/- 3.7 versus 3.0 +/- 2.6 years; p = 0.04) and had longer cardiopulmonary bypass (118 +/- 38 versus 85 +/- 28 minutes; p < 0.001) and aortic cross-clamp times (33 +/- 32 versus 14 +/- 21 minutes; p < 0.001). There were no differences between groups regarding diagnosis, weight, hospital or intensive care unit length of stay, ventilator time, or 12-hour chest tube output. Postoperative complications were similar between groups, including bleeding (0 of 21 versus 8 of 215; p = 0.8), neurologic injury (1 of 21 versus 9 of 215; p = 0.7), arrhythmias (1 of 21 versus 24 of 215; p = 0.6), and operative mortality (0 of 21 versus 1 of 215; p = 0.1). Group 1 AVV regurgitation significantly decreased after surgery (3.0 +/- 0.9 preoperatively versus 1.7 +/- 0.9 postoperatively; p < 0.001).

CONCLUSIONS

Atrioventricular valve surgery has been shown to improve late outcomes for single-ventricle patients. This study demonstrates that AVV surgery performed with the Fontan procedure increased operative times, but did not significantly increase perioperative morbidity or mortality. This information supports appropriate utilization of AVV surgery for single-ventricle patients.

Authors+Show Affiliations

Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19379889

Citation

Kerendi, Faraz, et al. "Perioperative Risks and Outcomes of Atrioventricular Valve Surgery in Conjunction With Fontan Procedure." The Annals of Thoracic Surgery, vol. 87, no. 5, 2009, pp. 1484-8; discussion 1488-9.
Kerendi F, Kramer ZB, Mahle WT, et al. Perioperative risks and outcomes of atrioventricular valve surgery in conjunction with Fontan procedure. Ann Thorac Surg. 2009;87(5):1484-8; discussion 1488-9.
Kerendi, F., Kramer, Z. B., Mahle, W. T., Kogon, B. E., Kanter, K. R., & Kirshbom, P. M. (2009). Perioperative risks and outcomes of atrioventricular valve surgery in conjunction with Fontan procedure. The Annals of Thoracic Surgery, 87(5), 1484-8; discussion 1488-9. https://doi.org/10.1016/j.athoracsur.2009.02.059
Kerendi F, et al. Perioperative Risks and Outcomes of Atrioventricular Valve Surgery in Conjunction With Fontan Procedure. Ann Thorac Surg. 2009;87(5):1484-8; discussion 1488-9. PubMed PMID: 19379889.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perioperative risks and outcomes of atrioventricular valve surgery in conjunction with Fontan procedure. AU - Kerendi,Faraz, AU - Kramer,Zachary B, AU - Mahle,William T, AU - Kogon,Brian E, AU - Kanter,Kirk R, AU - Kirshbom,Paul M, PY - 2008/11/08/received PY - 2009/02/18/revised PY - 2009/02/20/accepted PY - 2009/4/22/entrez PY - 2009/4/22/pubmed PY - 2009/5/15/medline SP - 1484-8; discussion 1488-9 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 87 IS - 5 N2 - BACKGROUND: Long-term outcomes of staged single-ventricle palliation can be impaired by atrioventricular valve (AVV) regurgitation. Atrioventricular valve repair or replacement has been shown to improve late outcomes, but little data exist regarding the associated perioperative morbidity. This study aimed to evaluate the additional perioperative risks associated with single-ventricle AVV surgery. METHODS: Two hundred thirty-six consecutive Fontan procedures were retrospectively reviewed. Group 1 (n = 21, with concomitant AVV repair [n = 19] or replacement [n = 2]) was compared with group 2 (n = 215, no AVV surgery) with regard to preoperative characteristics and perioperative outcomes. Atrioventricular valve regurgitation was graded as 1 (none or trivial) to 4 (severe). RESULTS: Group 1 patients were older (4.3 +/- 3.7 versus 3.0 +/- 2.6 years; p = 0.04) and had longer cardiopulmonary bypass (118 +/- 38 versus 85 +/- 28 minutes; p < 0.001) and aortic cross-clamp times (33 +/- 32 versus 14 +/- 21 minutes; p < 0.001). There were no differences between groups regarding diagnosis, weight, hospital or intensive care unit length of stay, ventilator time, or 12-hour chest tube output. Postoperative complications were similar between groups, including bleeding (0 of 21 versus 8 of 215; p = 0.8), neurologic injury (1 of 21 versus 9 of 215; p = 0.7), arrhythmias (1 of 21 versus 24 of 215; p = 0.6), and operative mortality (0 of 21 versus 1 of 215; p = 0.1). Group 1 AVV regurgitation significantly decreased after surgery (3.0 +/- 0.9 preoperatively versus 1.7 +/- 0.9 postoperatively; p < 0.001). CONCLUSIONS: Atrioventricular valve surgery has been shown to improve late outcomes for single-ventricle patients. This study demonstrates that AVV surgery performed with the Fontan procedure increased operative times, but did not significantly increase perioperative morbidity or mortality. This information supports appropriate utilization of AVV surgery for single-ventricle patients. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/19379889/Perioperative_risks_and_outcomes_of_atrioventricular_valve_surgery_in_conjunction_with_Fontan_procedure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(09)00340-3 DB - PRIME DP - Unbound Medicine ER -