Abstract
Background
Atrioventricular Valve Regurgitation (AVVR) is a risk factor for increased mortality in patients with single ventricular physiology. We postulate that by offloading the blood volume from the single ventricle, AVVR would improve without valvuloplasty.
Objective
We aimed to determine risk factors associated with AVVR and whether a Bidirectional Cavopulmonary Anastomosis (BCPA) alone would improve AVVR without valvuloplasty in our cohort of patients.
Material and methods
A retrospective review of 213 consecutive patients who underwent BCPA between January 2000 to August 2010 was conducted. Eighty patients with AVVR without valvuloplasty were analyzed. Eighty-nine patients required palliation prior to the BCPA. The median age and weight at surgery were 3 years +/−4.4 and 11.2 kg +/−11.4 respectively. 2D Echocardiography was used to quantify the degree of AVVR pre and postoperatively. Significant (moderate and severe) AVVR before BCPA was noted in 29 out of 213 patients (13.6 %). The risk factors associated with AVVR i.e. type of cardiac diagnosis, systemic ventricle, palliation prior to BCPA and age at BCPA were analyzed.
Result and conclusion
The overall mortality was 5.2 %. The operative mortality was significantly lower in patients operated between 2006 and 2010 as compared to between 2000 and 2005 (0.9 % versus 7.1 %) (p = 0.024). AVVR was significantly higher in patients who had right ventricle as systemic ventricle (p = 0.032) and unbalanced atrioventricular canal (p < 0.05). In the immediate postoperative period, presence of moderate AVVR improved (p < 0.05) from 21.3 to 8.8 %. However at mean follow up of 3.7+/−2.8 years, 12.5 % patients presented with moderate AVVR. In conclusion, the BCPA significantly offloaded the single ventricle and improved AVVR in patients with moderate regurgitation. However, improvement did not sustain at longer duration of follow up.
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Sivalingam, S., Krishnasamy, S., Hong, T.Y. et al. Cavopulmonary anastomosis without concomitant valvoplasty in patients with single ventricle physiology. Indian J Thorac Cardiovasc Surg 30, 6–10 (2014). https://doi.org/10.1007/s12055-014-0265-1
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DOI: https://doi.org/10.1007/s12055-014-0265-1