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Atrio-ventricular valve regurgitation in univentricular hearts: outcomes after repair†.
Interact Cardiovasc Thorac Surg. 2015 May; 20(5):622-9; discussion 629-30.IC

Abstract

OBJECTIVES

The aim was to describe the early and mid-term outcome after atrio-ventricular valve (AVV) repair in patients with univentricular hearts (UVHs) and to identify risk factors for AVV reoperation and death.

METHODS

This study is a retrospective review of patients undergoing valve repair for AVV regurgitation at any stage of univentricular palliation from 1998 to 2014. Patient- and procedure-related variables were analysed.

RESULTS

A total of 31 consecutive patients underwent 38 procedures for ≥ moderate AVV regurgitation at a median age of 3.6 years. Thirty-two percent of patients had a common AVV, 26% had two AVVs, 22% had a dominant tricuspid valve and 19% had a dominant mitral valve. All patients underwent valve repair as a first procedure without early mortality. At discharge, patients preserved their ventricular function (fractional shortening <30%: preoperative 16% vs postoperative 22.5%, NS). In 19% (n = 6) of patients, the procedure was considered as failed because of significant residual regurgitation. There were three late deaths [median delay: 1 year (range 0.7-13.6)] and three heart transplantations. Six patients underwent seven AVV reoperations [median delay: 2 years (range 0.2-7.6)]. Longer intensive care stay (P = 0.022), longer total postoperative hospital stay (P = 0.039), higher total number of surgeries (P = 0.039), lower body mass index (P = 0.042) and higher preoperative mean pulmonary pressure (P = 0.047) were univariate risk factors for death/transplantation. Failed first AVV repair (P = 0.01), higher total number of surgeries (P = 0.026), lower body mass index (P = 0.031), male gender (P = 0.031) and need for valve repair before bidirectional cavopulmonary connection (P = 0.036) were univariate risk factors for AVV reoperation. In multivariate analysis, no univariate risk factor reached statistical significance. Freedom from death/transplantation was 84% (CI 95%: 70%-98%) at 5 and 10 years. Survival free from AVV reoperation was 72% (CI 95%: 52%-92%) at 5 years and 62% at 10 years (CI 95%: 36%-88%). Mean follow-up of survivors was 4.7 years (SD ± 4.3; range 0.2-15.6). At last visit, 96% of survivors were in NYHA Class I-II. Ninety-two percent had a ≤ mild residual regurgitation.

CONCLUSIONS

In patients with a UVH and ≥ moderate AVV regurgitation, AVV repair is feasible without postoperative deterioration of their ventricular function. Nevertheless, these patients remain at increased risk for death/transplantation and AVV reoperation.

Authors+Show Affiliations

Department of Pediatric and Congenital Heart Disease-M3C, Marie Lannelongue Hospital, University Paris Sud, Le Plessis Robinson, France d.laux@ccml.fr.Department of Pediatric and Congenital Heart Disease-M3C, Marie Lannelongue Hospital, University Paris Sud, Le Plessis Robinson, France.Department of Pediatric and Congenital Heart Disease-M3C, Marie Lannelongue Hospital, University Paris Sud, Le Plessis Robinson, France.Department of Pediatric and Congenital Heart Disease-M3C, Marie Lannelongue Hospital, University Paris Sud, Le Plessis Robinson, France.Department of Pediatric and Congenital Heart Disease-M3C, Marie Lannelongue Hospital, University Paris Sud, Le Plessis Robinson, France.Department of Pediatric and Congenital Heart Disease-M3C, Marie Lannelongue Hospital, University Paris Sud, Le Plessis Robinson, France.Department of Pediatric and Congenital Heart Disease-M3C, Marie Lannelongue Hospital, University Paris Sud, Le Plessis Robinson, France.Department of Pediatric and Congenital Heart Disease-M3C, Marie Lannelongue Hospital, University Paris Sud, Le Plessis Robinson, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25690458

Citation

Laux, Daniela, et al. "Atrio-ventricular Valve Regurgitation in Univentricular Hearts: Outcomes After Repair†." Interactive Cardiovascular and Thoracic Surgery, vol. 20, no. 5, 2015, pp. 622-9; discussion 629-30.
Laux D, Vergnat M, Lambert V, et al. Atrio-ventricular valve regurgitation in univentricular hearts: outcomes after repair†. Interact Cardiovasc Thorac Surg. 2015;20(5):622-9; discussion 629-30.
Laux, D., Vergnat, M., Lambert, V., Gouton, M., Ly, M., Peyre, M., Roussin, R., & Belli, E. (2015). Atrio-ventricular valve regurgitation in univentricular hearts: outcomes after repair†. Interactive Cardiovascular and Thoracic Surgery, 20(5), 622-9; discussion 629-30. https://doi.org/10.1093/icvts/ivv011
Laux D, et al. Atrio-ventricular Valve Regurgitation in Univentricular Hearts: Outcomes After Repair†. Interact Cardiovasc Thorac Surg. 2015;20(5):622-9; discussion 629-30. PubMed PMID: 25690458.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atrio-ventricular valve regurgitation in univentricular hearts: outcomes after repair†. AU - Laux,Daniela, AU - Vergnat,Mathieu, AU - Lambert,Virginie, AU - Gouton,Marielle, AU - Ly,Mohamed, AU - Peyre,Marianne, AU - Roussin,Regine, AU - Belli,Emre, Y1 - 2015/02/16/ PY - 2014/09/18/received PY - 2014/12/19/accepted PY - 2015/2/19/entrez PY - 2015/2/19/pubmed PY - 2017/4/8/medline KW - Atrio-ventricular valve KW - Univentricular heart KW - Valve repair SP - 622-9; discussion 629-30 JF - Interactive cardiovascular and thoracic surgery JO - Interact Cardiovasc Thorac Surg VL - 20 IS - 5 N2 - OBJECTIVES: The aim was to describe the early and mid-term outcome after atrio-ventricular valve (AVV) repair in patients with univentricular hearts (UVHs) and to identify risk factors for AVV reoperation and death. METHODS: This study is a retrospective review of patients undergoing valve repair for AVV regurgitation at any stage of univentricular palliation from 1998 to 2014. Patient- and procedure-related variables were analysed. RESULTS: A total of 31 consecutive patients underwent 38 procedures for ≥ moderate AVV regurgitation at a median age of 3.6 years. Thirty-two percent of patients had a common AVV, 26% had two AVVs, 22% had a dominant tricuspid valve and 19% had a dominant mitral valve. All patients underwent valve repair as a first procedure without early mortality. At discharge, patients preserved their ventricular function (fractional shortening <30%: preoperative 16% vs postoperative 22.5%, NS). In 19% (n = 6) of patients, the procedure was considered as failed because of significant residual regurgitation. There were three late deaths [median delay: 1 year (range 0.7-13.6)] and three heart transplantations. Six patients underwent seven AVV reoperations [median delay: 2 years (range 0.2-7.6)]. Longer intensive care stay (P = 0.022), longer total postoperative hospital stay (P = 0.039), higher total number of surgeries (P = 0.039), lower body mass index (P = 0.042) and higher preoperative mean pulmonary pressure (P = 0.047) were univariate risk factors for death/transplantation. Failed first AVV repair (P = 0.01), higher total number of surgeries (P = 0.026), lower body mass index (P = 0.031), male gender (P = 0.031) and need for valve repair before bidirectional cavopulmonary connection (P = 0.036) were univariate risk factors for AVV reoperation. In multivariate analysis, no univariate risk factor reached statistical significance. Freedom from death/transplantation was 84% (CI 95%: 70%-98%) at 5 and 10 years. Survival free from AVV reoperation was 72% (CI 95%: 52%-92%) at 5 years and 62% at 10 years (CI 95%: 36%-88%). Mean follow-up of survivors was 4.7 years (SD ± 4.3; range 0.2-15.6). At last visit, 96% of survivors were in NYHA Class I-II. Ninety-two percent had a ≤ mild residual regurgitation. CONCLUSIONS: In patients with a UVH and ≥ moderate AVV regurgitation, AVV repair is feasible without postoperative deterioration of their ventricular function. Nevertheless, these patients remain at increased risk for death/transplantation and AVV reoperation. SN - 1569-9285 UR - https://www.unboundmedicine.com/medline/citation/25690458/Atrio_ventricular_valve_regurgitation_in_univentricular_hearts:_outcomes_after_repair†_ L2 - https://academic.oup.com/icvts/article-lookup/doi/10.1093/icvts/ivv011 DB - PRIME DP - Unbound Medicine ER -