Early surgical correction of atrioventricular valvular regurgitation in single-ventricle patients.
BACKGROUND
The purpose of this study is to evaluate the effectiveness of early surgical correction for atrioventricular valve regurgitation (AVVR) in single-ventricle patients.


METHODS
The medical records of 39 single-ventricle patients who underwent atrioventricular surgery more than once between 1996 and 2008 were reviewed.


RESULTS
The mean preoperative grade of AVVR was 2.6 ± 0.7. Four patients underwent valvular operations at first palliative surgery, 3 patients before bidirectional cavopulmonary connection, 13 at bidirectional cavopulmonary connection, 6 in the interstage between bidirectional cavopulmonary connection and Fontan, 10 at Fontan, and 3 after Fontan procedure. Surgical techniques for valve were edge-to-edge sutures for bridging leaflets, leaflet cleft repair, partial or complete annuloplasty with strip, or artificial valve implantation. Although there was no statistical significance, the patients who underwent early operation (AVVR grade less than 2) showed a tendency toward better atrioventricular valvular function during the postoperative follow-up (57.1 months, range: 2 ∼ 129 months). None of the patients whose preoperative AVVR grade less than 2 showed an AVVR more than 2 at the final echocardiography. There were 4 deaths overall due to sepsis, Fontan failure, and sudden cardiac arrest. Final echocardiographic findings showed a mean AVVR of 1.6 ± 0.8 and acceptable cardiac function. All living patients were in a good New York Heart Association functional class (1.07 ± 0.2).


CONCLUSIONS
Even though we could not find statistically significant evidence of benefit for early correction of AVVR in single-ventricle patients, the patients undergoing early valvular operation for regurgitation showed a tendency toward better atrioventricular valvular function at midterm.
Kwak
Jae Gun
JG
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, South Korea. switch.surgeon@gmail.com
Park
Chun Soo
CS
Lee
Chang-Ha
CH
Lee
Cheul
C
Kim
Soo-Jin
SJ
Song
Jin Young
JY
Shim
Woo-Sup
WS
D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006349:Heart Valve Diseases / Q000601:surgery*; D006351:Heart Valves / Q000002:abnormalities / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery; D006801:Humans; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome