Effect of Earlier Atrioventricular Valve Intervention on Survival After the Fontan Operation.

Published on Dec 15, 2020in American Journal of Cardiology2.57
· DOI :10.1016/J.AMJCARD.2020.09.028
Elizabeth H. Stephens2
Estimated H-index: 2
(Mayo Clinic),
Elizabeth H. Stephens25
Estimated H-index: 25
(Mayo Clinic)
+ 3 AuthorsFrank Cetta46
Estimated H-index: 46
(Mayo Clinic)
Source
Abstract
Whereas the prevalence and impact of atrioventricular valve (AVV) regurgitation in patients with single ventricle physiology has become increasingly apparent, the optimal timing for valve intervention is unclear. To investigate this, we performed a retrospective review of all 1,167 patients from the Mayo Clinic Fontan database. Thirteen percent (153 patients) had AVV repair or replacement during their staged single ventricle palliation. We found that patients with right ventricular morphology and common AVV were at increased risk for AVV intervention. Patients who underwent AVV intervention had increased risk of death/transplant compared with those who did not (hazards ratio [HR] = 1.75, 95% CI 1.37 to 2.23, p <0.001). With respect to valve intervention timing, whereas AVV intervention before Fontan presented similar risk for death/transplant compared with no AVV intervention (HR = 0.85, 95% CI 0.32 to 2.27, p = 0.74), intervention at time of Fontan had a significantly higher risk (HR = 1.46, 95% CI 1.09 to 1.97, p = 0.01), and intervention after Fontan had a much more substantial risk (HR = 3.83, 95% CI 2.54 to 5.79, p <0.001). AVV repair failure occurred in 11% of patients. In terms of relative risk of valve repair versus replacement, in post-Fontan AVV intervention patients, AVV replacement carried a 2.9 fold risk of death/transplant compared with AVV repair. In conclusion, AVV disease remains a considerable challenge for durable Fontan physiology. This data demonstrates that earlier intervention on valve pathology improves survival with the Fontan circulation. Continued surveillance of single ventricle patients and prompt referral of those with valve pathology can improve outcomes in this challenging population.
References17
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It has been 50 years since Francis Fontan pioneered the operation that today bears his name. Initially designed for patients with tricuspid atresia, this procedure is now offered for a vast array o...
119 CitationsSource
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33 CitationsSource
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Last. Igor E. Konstantinov (University of Melbourne)H-Index: 41
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25 CitationsSource
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271 CitationsSource
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300 CitationsSource
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25 CitationsSource
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12 CitationsSource
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Objectives This study examined survival after surgical palliation in children with single-ventricle physiology. Background Contemporary surgical outcomes for the entire population of newborns undergoing single-ventricle palliation are unclear. Methods In a single-center review of 499 consecutive patients undergoing univentricular palliation from 1990 to 2008, predictors of mortality were determined using multivariate risk analysis, stratified for each post-operative stay and interim states. Resu...
109 CitationsSource
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#1Tarek Alsaied (University of Cincinnati Academic Health Center)H-Index: 11
In this review, we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our hope is to provide a summary of the latest articles published recently in other journals in our field. The articles address the following: (1) transcatheter closure of sinus venous atrial septal defect which is feasible in adults with careful planning, (2) exercise echocardiography in children with hypertrophic cardiomyopathy which was found to be very helpful ...
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