Long-term results of concomitant atrioventricular valve intervention and the Fontan operation

Abstract

OBJECTIVES: The optimal timing for atrioventricular valve (AVV) repair in patients with a Fontan circulation remains controversial. Few studies have reported the long-term outcomes of AVV repair concomitant with a Fontan operation. METHODS: From January 2006 to December 2018, a total of 89 patients who developed moderate or severe AVV regurgitation before a Fontan operation were divided into 2 groups: Group 1, including 37 patients who did not undergo concomitant AVV repair; and group 2, including 52 patients who received AVV repair concomitant with a Fontan operation. RESULTS: The mean age at the time of the Fontan operation was 6.74 years for group 1 and 8.96 years for group 2, respectively. Early death occurred in 3 patients [2 patients (5.4%) in group 2, patient 1 (1.9%) in group 1]. Freedom from long-term death, cardiac function reduction and protein-losing enteropathy were similar among the 2 groups. Common AVV function was apparently poorer than mitral valve function after repair [hazard ratio (HR) 3.83, 95% confidence interval (CI) 1.31-11.17; P = 0.014]. The occurrence of AVV valve failure in group 1 was lower than that in group 2 (HR 0.44, 95% CI 0.22-0.91; P = 0.026). AVV function became worse during the follow-up period than that at discharge in both groups (P = 0.03 in group 1 and P = 0.001 in group 2). CONCLUSIONS: The long-term results of AVV repair concomitant with a Fontan operation are favourable. © 2021 The Author(s). Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.