title: Long-term results of modified Fontan operation for single-ventricle patients associated with atrioventricular valve regurgitation.
abstract: BACKGROUND
  The long-term outcome of modified Fontan operation concomitant with a valve operation for atrioventricular valve (AVV) regurgitation is not well described.
  
  
  METHODS
  Between 1977 and 2003, 500 children who underwent modified Fontan operation were subdivided into 192 with AVV plasty (group P) and 308 without AVV plasty (group N). Factors associated with patient outcome were investigated retrospectively.
  
  
  RESULTS
  Surgical techniques to correct valve incompetence included circular annuloplasty, partial annuloplasty with Kaye-Reed methods, edge-to-edge repair methods, and valvoplasty, which were combined according to the etiology of the valve lesion. The estimated actuarial survival rates at 10 and 20 years were, respectively, 82.0% and 76.6% in group P (p < 0.05) and 90.8% and 86.8% in group N (p = 0.001). The estimated actuarial survival rates at 10 years among patients with AVV plasty did not show a statistically significant difference (circular annuloplasty, 79.0%; partial annuloplasty, 81.6%; edge-to-edge, 83.3%; valvoplasty, 82.6%; p = 0.90). A Cox regression model revealed that a higher preoperative ventricular ejection fraction was associated with a significant reduction in long-term mortality in group P (hazard ratio, 0.921; 95% confidence interval, 0.873 to 0.972; p < 0.05). Each repair method showed acceptable durability at medium-term follow-up, without progression of lesions.
  
  
  CONCLUSIONS
  Given worse results with poor ventricular function, early intervention against valve pathology before development of ventricular failure may improve long-term outcomes. Multiple methods are appropriate for a variety of valve lesions; however, circular annuloplasty remains a reliable repair option due to its technical simplicity.
authors.affiliation: Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan. ujinaito@gmail.com
authors.forename: Yuji
authors.initials: Y
authors.lastname: Naito
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hiramatsu
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kurosawa
authors.forename: Kouta
authors.initials: K
authors.lastname: Agematsu
authors.forename: Masaki
authors.initials: M
authors.lastname: Sasoh
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakanishi
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Imai
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamazaki
mesh_terms: D000015:Abnormalities, Multiple / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000379:methods* / Q000401:mortality; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018785:Tricuspid Atresia / Q000503:physiopathology / Q000601:surgery*; D014261:Tricuspid Valve / Q000002:abnormalities / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000151:congenital / Q000503:physiopathology / Q000601:surgery*