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Long-Term Outcomes of Atrioventricular Valve Surgery in Patients with Functional Single Ventricle: Should We Avoid Valve Replacement?

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Abstract

Atrioventricular valve regurgitation (AVVR) is associated with increased morbidity and mortality in patients with single ventricle physiology. The purpose of this study was to evaluate the long-term results of the surgical management of AVVR and to analyze the effects of AV valve replacement. The medical records of 38 single ventricle patients who underwent atrioventricular valve surgery more than once between January 2001 and March 2018 were retrospectively reviewed. We analyzed and compared clinical data of patients who underwent valve replacement as an initial treatment (n = 8) for AVVR with patients who initially underwent valve repair (n = 30). The median follow-up duration was 98.1 months (range, 0.9–209.6 months). There was one early mortality and seven late mortalities. Freedom from reoperation between the two groups at 15 years of follow-up was significantly different: 18.3% in the repair group and 100% in the replacement group (p = 0.013). The replacement group showed a better overall survival rate (100%) at 15 years than the repair group (68.5%) without statistical significance (p = 0.097). All mortalities occurred in the repair group. Nine patients in the repair group (30%) and one patient in the replacement group (12.5%) showed preoperative ventricular dysfunction. RV-type single ventricle with atrioventricular (AV) valve annular dilatation was found out as a risk factor of AVV replacement both in univariate (p = 0.04) and multivariate (p = 0.004) analysis. AV valve replacement might be considered as a primary treatment option for patients who have an annular dilation with an RV-type single ventricle rather than repeated valvuloplasty.

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Abbreviations

AV:

Atrioventricular

AVVR:

Atrioventricular valve regurgitation

IRB:

Institutional review board

IQR:

Interquartile range

RV:

Right ventricle

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Acknowledgements

Dr. Lim JH and Dr. Kwak JG equally contributed to this paper as 1st author.

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Author notes

  1. JaeHong Lim and JaeGun Kwak equally contributed to this paper as 1st author.

Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Puchon, Republic of Korea

    Jae Hong Lim

  2. Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea

    Jae Gun Kwak, Jooncheol Min, Sungkyu Cho & Woong-Han Kim

  3. Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Woong-Han Kim

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  1. Jae Hong Lim
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Correspondence to Woong-Han Kim.

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Lim, J.H., Kwak, J.G., Min, J. et al. Long-Term Outcomes of Atrioventricular Valve Surgery in Patients with Functional Single Ventricle: Should We Avoid Valve Replacement?. Pediatr Cardiol 42, 1546–1553 (2021). https://doi.org/10.1007/s00246-021-02639-5

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  • DOI: https://doi.org/10.1007/s00246-021-02639-5

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