title: Results of Fontan operation in patients with atrioventricular valve regurgitation.
abstract: OBJECTIVE
  The influence of concomitant atrioventricular valve regurgitation on the results of Fontan operation remains disputable. The goal of this study was to compare early and late results of Fontan operation performed in patients with mild or moderate-to-severe atrioventricular valve regurgitation.
  
  
  METHODS
  For retrospective analysis, patients with atrioventricular valve insufficiency assessed by echocardiography were divided into three groups based on the severity of regurgitation and its repair or non-repair during Fontan operation: Group 1: unrepaired regurgitation 1-2+ (n = 33); Group 2: unrepaired regurgitation 3-4+ (n = 11); Group 3: repaired regurgitation 3-4+ (n = 35). Actuarial survival was estimated by the Kaplan-Meier method, followed by the log-rank test to compare survival curves between groups.
  
  
  RESULTS
  Hospital mortality rates in Groups 1 through 3 reached 3, 27 and 14%, respectively (P = 0.015, Group 1 vs Group 2). The frequency of non-lethal complications did not significantly differ between groups. However, patients from Group 2 required significantly more intensive inotropic support, longer mechanical ventilation and had larger pleural effusion. Predicted survival after Fontan operation was the worst in Group 2 (P = 0.016, Group 2 vs Group 1). The frequency of non-lethal late complications was also the highest in Group 2 (50 vs 17 or 11%); however, the difference did not reach statistical significance (P = 0.13 and 0.069, respectively). The severity of atrioventricular valve regurgitation during the follow-up did not significantly change when compared with discharge after the repair in Group 2 or Group 3 (P = 0.19 and 0.52, respectively), and significantly increased in Group 1 (P = 0.003). However, this increase did not have clinical significance during the reported period of follow-up.
  
  
  CONCLUSIONS
  If unrepaired, concomitant moderate-to-severe atrioventricular valve regurgitation significantly worsens the results of the Fontan procedure. Longer observation is needed to define the strategy in patients with mild atrioventricular valve regurgitation that remained unrepaired during Fontan operation.
authors.affiliation: Bakoulev Center for Cardiovascular Surgery, Moscow, Russia.
authors.forename: Vladimir P
authors.initials: VP
authors.lastname: Podzolkov
authors.affiliation: Bakoulev Center for Cardiovascular Surgery, Moscow, Russia.
authors.forename: Mikhail R
authors.initials: MR
authors.lastname: Chiaureli
authors.affiliation: Bakoulev Center for Cardiovascular Surgery, Moscow, Russia.
authors.forename: Ivan A
authors.initials: IA
authors.lastname: Yurlov
authors.affiliation: Bakoulev Center for Cardiovascular Surgery, Moscow, Russia.
authors.forename: Mikhail M
authors.initials: MM
authors.lastname: Zelenikin
authors.affiliation: Bakoulev Center for Cardiovascular Surgery, Moscow, Russia.
authors.forename: Dmitry V
authors.initials: DV
authors.lastname: Kovalev
authors.affiliation: Bakoulev Center for Cardiovascular Surgery, Moscow, Russia.
authors.forename: Vera I
authors.initials: VI
authors.lastname: Dontsova
authors.affiliation: Bakoulev Center for Cardiovascular Surgery, Moscow, Russia.
authors.forename: Tatiana O
authors.initials: TO
authors.lastname: Astrakhantseva
authors.affiliation: Bakoulev Center for Cardiovascular Surgery, Moscow, Russia.
authors.forename: Neele A
authors.initials: NA
authors.lastname: Putiato
authors.affiliation: Bakoulev Center for Cardiovascular Surgery, Moscow, Russia zaets001@yahoo.com.
authors.forename: Sergey B
authors.initials: SB
authors.lastname: Zaets
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects* / Q000379:methods; D006330:Heart Defects, Congenital / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011184:Postoperative Period; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D014463:Ultrasonography
keywords: Atrioventricular valve regurgitation; Atrioventricular valve repair; Congenital; Fontan operation; Heart defects; Risk factors