title: Perioperative risks and outcomes of atrioventricular valve surgery in conjunction with Fontan procedure.
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.affiliation: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Faraz
authors.initials: F
authors.lastname: Kerendi
authors.forename: Zachary B
authors.initials: ZB
authors.lastname: Kramer
authors.forename: William T
authors.initials: WT
authors.lastname: Mahle
authors.forename: Brian E
authors.initials: BE
authors.lastname: Kogon
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Kanter
authors.forename: Paul M
authors.initials: PM
authors.lastname: Kirshbom
mesh_terms: D002648:Child; D002675:Child, Preschool; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D005260:Female; D018729:Fontan Procedure / Q000379:methods / Q000401:mortality*; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D007431:Intraoperative Complications / Q000453:epidemiology*; D007902:Length of Stay; D008297:Male; D019990:Perioperative Care; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*