Outcomes And Predictors Of Atrioventricular Valve Repair In Patients With Single-ventricle Physiology
Eliana Al Haddad, MD, David Blitzer, Brett Anderson, Anne Ferris, Lindsay Freud, Marc Richmond, Paul Chai, Damien LaPar, Emile Bacha, David Kalfa.
Columbia University Medical Center, New York, NY, USA.
We aimed to investigate the optimal timing, outcomes and predictors for atrioventricular valve(AVV) surgery in children with single ventricle physiology and assess risk factors for reoperation, heart transplant and death
This is a retrospective review of all single ventricle patients undergoing AVV surgery at our institution from 2005-2018. Primary outcomes were AVV reoperation and mortality/heart transplant. Patient-related and surgery-related factors were analyzed for effect on survival, transplant, and reintervention.
36 single-ventricle patients underwent AVV surgery at a median age of 5.5months(4d-46.9y). Thirty patients(83.3%) had hypoplastic left heart syndrome. 9(25%) had AVV regurgitation before stage I. Most frequent timing for AVV repair was at Stage II(n=14;38.9%). Hospital mortality was 13.8%(n=5). Overall follow-up was 2.5y(5d-14.7y). Late mortality was 8.3%(n=3). Four patients required a transplant. AVV reoperation rate was 19.6%(n=10) after a median period of 3.1y(2.4months-9.2y). An AVV repair performed before the Fontan was associated with a higher risk of death/transplant(30.6% vs. 0%; p=0.034) and AVV reoperation (27.8% vs. 0%; p=0.039) compared to patients who had AVV surgery at the time of the Fontan or after. A lower BSA and cardiac reintervention before discharge were also associated with a higher risk of death/transplant(p=0.044 and p=0.021).
Single ventricle patients who require an AVV surgery have a significant risk of death, transplant and AVV reoperation. AVV repair performed before the time of the Fontan seems to be associated with worse outcomes, possibly indicating a higher degree of severity and urgency of the operation.