What Factors Predict Long-Term Survival and Valve Durability in Patients With Atrioventricular Valve Regurgitation in Single-Ventricle Physiology?

被引:9
作者
Jang, Woo Sung [1 ]
Kim, Woong-Han [1 ]
Choi, Kwangho [1 ]
Lee, Jeong Ryul [1 ]
Kim, Yong Jin [1 ]
Kwon, Bo Sang [2 ]
Kim, Gi Beom [2 ]
机构
[1] Seoul Natl Univ, Coll Med, Seoul Natl Univ Childrens Hosp, Dept Thorac & Cardiovasc Surg, Seoul 110744, South Korea
[2] Seoul Natl Univ, Coll Med, Seoul Natl Univ Childrens Hosp, Dept Pediat, Seoul 110744, South Korea
关键词
Atrioventricular valve regurgitation; Single ventricle; Valve replacement; Heterotaxy syndromes; FONTAN PROCEDURE; TRICUSPID-VALVE; REPAIR; IMPACT;
D O I
10.1007/s00246-013-0650-3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Although significant atrioventricular valve regurgitation (AVVR) is well known for its association with increased morbidity and mortality in patients with single-ventricle physiology, there is a lack of consensus in management of AVVR. The purpose of this study was to analyze the clinical outcomes in patients receiving AVV repair or replacement. From 2001 to 2010, a total of 33 patients (25 male and 8 female) with more than moderate-degree AVVR among 160 patients who underwent staged single-ventricle palliation were included. The median follow-up duration was 6.0 years (range 0.1-14.1). Valve repair (n = 27) or valve replacement (n = 6) was performed at the initial surgery. There were six late mortalities (18.18 %): five in the repair group and one in the replacement group and seven morbidities. Among patients with valve repair, 11 were required to undergo redo-valve operations (valve repair n = 6, valve replacement n = 5) due to deteriorated valve function. Initial shunt procedure (p = 0.04) and arrhythmia (p = 0.01) were risk factors for survival. Freedom from reoperation in the valve replacement group was higher than that in the valve repair group (67.0 +/- A 9.7 and 44.6 +/- A 11.2 % at 5 and 6 years, respectively, p = 0.03). Need for early repair (p = 0.02), presence of mitral- or tricuspid-dominant AVV (p = 0.005), and male sex (p = 0.04) were risk factors for valve durability. Early valve regurgitation affects valve durability. Thus, successful repair in the early stage may improve later outcomes. Therefore, aggressive valve surgery was required and AVV replacement might be one of the options for selected patients.
引用
收藏
页码:1366 / 1373
页数:8
相关论文
共 18 条
[1]   Edge-to-edge repair of common atrioventricular or tricuspid valve in patients with functionally single ventricle [J].
Ando, Makoto ;
Takahashi, Yukihiro .
ANNALS OF THORACIC SURGERY, 2007, 84 (05) :1571-1577
[2]   Long-Term Functional Analysis of the Atrioventricular Valve in Patients Undergoing Single Ventricle Palliation [J].
Ando, Makoto ;
Takahashi, Yukihiro .
ANNALS OF THORACIC SURGERY, 2011, 92 (05) :1767-1773
[3]   SYSTEMIC VENTRICULAR SIZE AND PERFORMANCE BEFORE AND AFTER BIDIRECTIONAL CAVOPULMONARY ANASTOMOSIS [J].
BERMAN, NB ;
KIMBALL, TR .
JOURNAL OF PEDIATRICS, 1993, 122 (06) :S63-S76
[4]   The Fontan procedure - Contemporary techniques have improved long-term outcomes [J].
d'Udekem, Yves ;
Iyengar, Ajay J. ;
Cochrane, Andrew D. ;
Grigg, Leeanne E. ;
Ramsay, James M. ;
Wheaton, Gavin R. ;
Penny, Dan J. ;
Brizard, Christian P. .
CIRCULATION, 2007, 116 (11) :I157-I164
[5]  
Friesen CLH, 2004, J HEART VALVE DIS, V13, P962
[6]   Long-term outcome of infants with single ventricle and total anomalous pulmonary venous connection [J].
Gaynor, JW ;
Collins, MH ;
Rychik, J ;
Gaughan, JP ;
Spray, TL .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1999, 117 (03) :506-514
[7]   Aortopulmonary Collaterals After Bidirectional Cavopulmonary Connection or Fontan Completion Quantification With MRI [J].
Grosse-Wortmann, Lars ;
Al-Otay, Abdulmajeed ;
Yoo, Shi-Joon .
CIRCULATION-CARDIOVASCULAR IMAGING, 2009, 2 (03) :219-225
[8]   Management and outcomes of right atrial isomerism: A 26-year experience [J].
Hashmi, A ;
Abu-Sulaiman, R ;
McCrindle, BW ;
Smallhorn, JF ;
Williams, WG ;
Freedom, RM .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1998, 31 (05) :1120-1126
[9]   Atrioventricular valve repair in patients with functional single-ventricle physiology: Impact of ventricular and valve function and morphology on survival and reintervention [J].
Honjo, Osami ;
Atlin, Cori R. ;
Mertens, Luc ;
Al-Radi, Osman O. ;
Redington, Andrew N. ;
Caldarone, Christopher A. ;
Van Arsdell, Glen S. .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2011, 142 (02) :326-+
[10]   Modified Fontan procedure in ninety-nine cases of atrioventricular valve regurgitation [J].
Imai, Y ;
Takanashi, Y ;
Hoshino, S ;
Terada, M ;
Aoki, M ;
Ohta, J .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1997, 113 (02) :262-268