PMID- 25825197
OWN - NLM
STAT- MEDLINE
DCOM- 20150803
LR  - 20150508
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 99
IP  - 5
DP  - 2015 May
TI  - Outcomes of atrioventricular valve operation in patients with Fontan circulation.
PG  - 1632-8
LID - S0003-4975(15)00147-2 [pii]
LID - 10.1016/j.athoracsur.2015.01.035 [doi]
AB  - BACKGROUND: Data on outcomes of atrioventricular (AV) valve surgical procedures 
      in patients with Fontan circulation are limited. METHODS: We conducted a 
      retrospective review of all children with Fontan circulation who underwent AV 
      valve operations. RESULTS: From 1981 to 2014, 581 patients underwent Fontan 
      operations, and 9.3% (54/581) of them required AV valve operations. The first AV 
      valve operation was performed before (n = 32), during (n = 15), or after (n = 7) 
      the Fontan operation. The mean follow-up time was 9.8 +/- 7.1 years (range, 6 
      months to 32 years). Operative mortality for the initial AV valve operation was 
      1.9% (1/54) and occurred in a patient who had the initial valve operation 
      concomitantly with the Fontan. Late mortality was 5.7% (3/53). Heart 
      transplantation was performed in 13.0% (7/54) of patients. Freedom from death or 
      transplantation after the first AV valve operation was 89.8 +/- 4.4% at 5 years 
      (95% confidence interval [CI], 77.1 to 95.6) and 81.0 +/- 6.2% at 10 years (95% CI, 
      65.0 to 90.2). Reoperation on the AV valve was performed in 44.4% (24/54) of 
      patients. The median time to initial valve reoperation was 3.1 years 
      (interquartile range, 0.8 to 7.4 years). Freedom from reoperation or 
      transplantation was 63.4 +/- 7.0% at 5 years (95% CI, 48.2 to 75.3) and 48.9 +/- 7.9% 
      at 10 years (95% CI, 32.8 to 63.2). Freedom from moderate or more regurgitation 
      in patients who had not undergone reoperation or transplantation was 74.0 +/- 6.9% 
      (95% CI, 57.5 to 84.8) at 5 years and 67.5 +/- 7.7% (95% CI:,50.0 to 80.0) at 10 
      years. After initial valve operation, thromboembolic events occurred in 13.0% 
      (7/54) of patients, stroke occurred in 24.1% (13/54) of patients, pacemaker 
      insertion was required in 16.7% (9/54) of patients, and protein-losing 
      enteropathy was diagnosed in 7.4% (4/54) of patients. Of the 43 surviving 
      transplant-free patients, 62.8% (27/43) were in New York Heart Association (NYHA) 
      class I, 34.9% (15/43) were in NYHA class II, and 1 patient was in NYHA class 
      III. CONCLUSIONS: The AV valve operation done before, during, or after the Fontan 
      operation is associated with low operative mortality but a high reoperation rate 
      with significant risk of late death, transplantation, and persistent AV valve 
      regurgitation.
CI  - Copyright (c) 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Liu, Victor J H
AU  - Liu VJ
AD  - Royal Children's Hospital, Melbourne, Victoria, Australia; University of 
      Melbourne, Melbourne, Victoria, Australia.
FAU - Yong, Matthew S
AU  - Yong MS
AD  - Royal Children's Hospital, Melbourne, Victoria, Australia.
FAU - d'Udekem, Yves
AU  - d'Udekem Y
AD  - Royal Children's Hospital, Melbourne, Victoria, Australia; University of 
      Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, 
      Melbourne, Victoria, Australia.
FAU - Weintraub, Robert G
AU  - Weintraub RG
AD  - Royal Children's Hospital, Melbourne, Victoria, Australia; University of 
      Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, 
      Melbourne, Victoria, Australia.
FAU - Praporski, Slavica
AU  - Praporski S
AD  - Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's 
      Research Institute, Melbourne, Victoria, Australia.
FAU - Brizard, Christian P
AU  - Brizard CP
AD  - Royal Children's Hospital, Melbourne, Victoria, Australia; University of 
      Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, 
      Melbourne, Victoria, Australia.
FAU - Konstantinov, Igor E
AU  - Konstantinov IE
AD  - Royal Children's Hospital, Melbourne, Victoria, Australia; University of 
      Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, 
      Melbourne, Victoria, Australia. Electronic address: igor.konstantinov@rch.org.au.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150329
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - *Cardiac Valve Annuloplasty
MH  - Child, Preschool
MH  - Female
MH  - *Fontan Procedure
MH  - Heart Defects, Congenital/complications/mortality/*surgery
MH  - Heart Transplantation
MH  - Heart Valve Diseases/congenital/mortality/*surgery
MH  - Humans
MH  - Infant
MH  - Male
MH  - Mitral Valve/*abnormalities
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Tricuspid Valve/*abnormalities
EDAT- 2015/04/01 06:00
MHDA- 2015/08/04 06:00
CRDT- 2015/04/01 06:00
PHST- 2014/12/01 00:00 [received]
PHST- 2014/12/27 00:00 [revised]
PHST- 2015/01/06 00:00 [accepted]
PHST- 2015/04/01 06:00 [entrez]
PHST- 2015/04/01 06:00 [pubmed]
PHST- 2015/08/04 06:00 [medline]
AID - S0003-4975(15)00147-2 [pii]
AID - 10.1016/j.athoracsur.2015.01.035 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2015 May;99(5):1632-8. doi: 10.1016/j.athoracsur.2015.01.035. 
      Epub 2015 Mar 29.