Outcomes Of Right-sided Atrioventricular Valve Surgery In Congenitally Corrected Transposition
Elizabeth Stephens, MD, Ph.D., Ahmed A. Abedlrehim, MBBCh, William R. Miranda, MD, Heidi M. Connolly, MD, Joseph A. Dearani, MD.
Mayo Clinic, Rochester, MN, USA.
Objective(s): Left-sided atrioventricular valve (morphologic tricuspid valve) regurgitation has been implicated in the development of systemic ventricular failure in congenitally corrected transposition (ccTGA), but the prevalence and outcomes of right-sided atrioventricular valve (RAVV, morphologic mitral valve of sub-pulmonary ventricle) regurgitation has not well been studied.
Methods: Of 104 ccTGA patients undergoing atrioventricular valve surgery from 1983-2021, 21 underwent RAVV surgery. Retrospective review of etiology of regurgitation, operative details, and outcomes of the 21 patients was performed.
Results: Median age was 37 years (IQR 29, 57) and 17 (81%) had intrinsic RAVV pathology (Table). 14 patients (68%) underwent repair and 7 (32%) replacement, while 14 patients (67%) had concomitant replacement of left-sided atrioventricular valve. There was one operative mortality (5%) in a patient with severe acute-on-chronic heart failure due to worsening valve regurgitation who underwent an emergent operation. During a median follow-up of 7 years IQR (1-15), four patients (19%) had died. Among the 14 patients who underwent repair, recurrent ≥moderate regurgitation was seen in 43%, 37% and 50% of repairs with annular, leaflet, and lead-induced regurgitation, respectively.
Conclusions: RAVV disease occurs much less frequently than left-sided disease in ccTGA patients. Intrinsic valve disease is the most common etiology, but this appears less amenable to durable repair strategies compared to mitral repair in the systemic position, and ccTGA patients may benefit from replacement.
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