Abstract
Objective
The effect of ventricular dominance and previous atrioventricular valve (AVV) surgery
on patient outcomes after Fontan operation remains unclear. We sought to determine
the effect of ventricular dominance and previous AVV surgery on transplantation-free
survival and long-term AVV competency in patients with atrioventricular septal defect
(AVSD) and Fontan circulation.
Methods
We conducted a retrospective study of 1703 patients in the Australia and New Zealand
Fontan Registry, who survived Fontan operation between 1987 and 2021.
Results
Of 174 patients with AVSD, 60% (105/174) had right ventricular (RV) dominance and
40% (69/174) had left ventricular (LV) dominance. The cumulative incidence of moderate
or greater AVV regurgitation at 25 years after Fontan operation in patients with LV
dominance was 56% (95% CI, 35%-72%), compared with 54% (95% CI, 40%-67%) in patients
with RV dominance (P = .6). Nonetheless, transplantation-free survival at 25 years in patients with LV
dominance was 94% (95% CI, 86%-100%), compared with 67% (95% CI, 52%-87%) in patients
with RV dominance (hazard ratio, 5.9; 95% CI, 1.4-25.4; P < .01). Of note, transplantation-free survival was not different in patients who
underwent AVV surgery before or at Fontan completion compared with those who did not
(15 years: 81% [95% CI, 62%-100%] vs 88% [95% CI, 81%-95%]; P = .3).
Conclusions
In patients with AVSD and Fontan circulation the rate of moderate or greater common
AVV regurgitation is similar in those with LV and RV dominance. RV dominance, rather
than previous AVV surgery, is a risk factor for death or transplantation.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
AVSD (atrioventricular septal defect), AVV (atrioventricular valve), HR (hazard ratio), LV (left ventricular), RV (right ventricular)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Thoracic and Cardiovascular SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Long-term outcomes of single-ventricle palliation for unbalanced atrioventricular septal defects: Fontan survivors do better than previously thought.J Thorac Cardiovasc Surg. 2017; 153: 430-438
- Long-term outcomes of atrioventricular septal defect and single ventricle: a multicenter study.J Thorac Cardiovasc Surg. 2022; 163: 1166-1175
- Common atrioventricular valve failure during single ventricle palliation.Eur J Cardiothorac Surg. 2017; 51: 1037-1043
- Atrioventricular valve failure in Fontan palliation.J Am Coll Cardiol. 2019; 73: 810-822
- Relationship of ventricular morphology and atrioventricular valve function to long-term outcomes following Fontan procedures.J Am Coll Cardiol. 2020; 76: 419-431
- Long-term outcomes in single-ventricle congenital heart disease.Circulation. 2018; 138: 2718-2720
- Successful atrioventricular valve repair improves long-term outcomes in children with unbalanced atrioventricular septal defect.J Thorac Cardiovasc Surg. 2017; 154: 2019-2027
- The Australia and New Zealand Fontan Registry: description and initial results from the first population-based Fontan registry.Intern Med J. 2014; 44: 148-155
- Morphologic analysis of common atrioventricular valves in patients with right atrial isomerism.Pediatr Cardiol. 1997; 18: 107-111
- Common atrioventricular valve guarding double inlet atrioventricular connexion: natural history and surgical results in 76 cases.Int J Cardiol. 1990; 28: 7-17
- Atrioventricular valve surgery: restoration of the fibrous skeleton of the heart.J Thorac Cardiovasc Surg. 2021; 162: 360-365
- Commentary: skeleton in the closet: toward durable repair of atrioventricular valve in univentricular circulation.J Thorac Cardiovasc Surg. 2022; 163: 1176-1177
- Fibrous skeleton of the heart: anatomic overview and evaluation of pathologic conditions with CT and MR imaging.Radiographics. 2017; 37: 1330-1351
- Single ventricle: repair of atrioventricular valve using the bridging technique.Multimed Man Cardiothorac Surg. 2015; 2015: mmv027
- Bridging annuloplasty for common atrioventricular valve regurgitation.Ann Thorac Surg. 1995; 59: 1003-1005
- Polytetrafluoroethylene bridge for atrioventricular valve repair in single-ventricle palliation.J Thorac Cardiovasc Surg. 2015; 149: 641-643
- Outcomes of common atrioventricular valve repair in patients with single-ventricle physiology - indication, timing and repair techniques.Circ J. 2019; 83: 647-653
- Long-term outcomes of common atrioventricular valve plasty in patients with functional single ventricle.Interact Cardiovasc Thorac Surg. 2013; 18: 259-265
- Mid-term result of atrioventricular valve replacement in patients with a single ventricle.Interact Cardiovasc Thorac Surg. 2018; 27: 895-900
- Tricuspid valve replacement in failing Fontan circulation with severe ventricular dysfunction: the road not taken?.J Thorac Cardiovasc Surg. 2018; 156: e141-e143
- Atrioventricular valve replacement in single-ventricle circulation: a viable option?.Interact Cardiovasc Thorac Surg. 2019; 27: 900-901
- Management of the bad atrioventricular valve in Fontan… Time for a change.J Thorac Cardiovasc Surg. 2019; 158: 1643-1648
- Atrioventricular valve repair in patients with functional single-ventricle physiology: impact of ventricular and valve function and morphology on survival and reintervention.J Thorac Cardiovasc Surg. 2011; 142: 326-335
- Long-term outcome after atrioventricular valve surgery following modified Fontan operation.Cardiol Young. 2011; 21: 83-88
- Effect of earlier atrioventricular valve intervention on survival after the Fontan operation.Am J Cardiol. 2020; 137: 103-110
Article info
Publication history
Published online: April 20, 2022
Accepted:
April 5,
2022
Received in revised form:
March 1,
2022
Received:
October 22,
2021
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery
ScienceDirect
Access this article on ScienceDirectLinked Article
- Commentary: The hit paradeThe Journal of Thoracic and Cardiovascular SurgeryVol. 165Issue 2
- PreviewIn the Venn diagram overlap of characteristics for single-ventricle candidacy, those with both unbalanced atrioventricular (AV) septal defects and significant AV valve regurgitation are among the greatest risk for palliation failure. In this issue of the Journal, King and colleagues1 present an analysis of the Australia and New Zealand Fontan Registry that attempts to tease apart the contributions of ventricular dominance (right ventricle [RV] vs left) and AV-valve surgery in this population to better profile those at greatest risk for death or transplantation.
- Full-Text
- Preview
