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Original Articles: Pediatric Cardiac

Perioperative Risks and Outcomes of Atrioventricular Valve Surgery in Conjunction With Fontan Procedure

^a Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
^b Sibley Heart Center, Children's Healthcare of Atlanta, Atlanta, Georgia

Accepted for publication February 20, 2009.

^_* Address correspondence to Dr Kirshbom, 1365 Clifton Rd, Suite A2100, Atlanta, GA 30322 (Email: paul.kirshbom{at}emoryhealthcare.org).

Presented at the Fifty-fifth Annual Meeting of the Southern Thoracic Surgical Association, Austin, TX, Nov 5–8, 2008.

Background: Long-term outcomes of staged single-ventricle palliation can be impaired by atrioventricular valve (AVV) regurgitation. Atrioventricular valve repair or replacement has been shown to improve late outcomes, but little data exist regarding the associated perioperative morbidity. This study aimed to evaluate the additional perioperative risks associated with single-ventricle AVV surgery.

Methods: Two hundred thirty-six consecutive Fontan procedures were retrospectively reviewed. Group 1 (n = 21, with concomitant AVV repair [n = 19] or replacement [n = 2]) was compared with group 2 (n = 215, no AVV surgery) with regard to preoperative characteristics and perioperative outcomes. Atrioventricular valve regurgitation was graded as 1 (none or trivial) to 4 (severe).

Results: Group 1 patients were older (4.3 ± 3.7 versus 3.0 ± 2.6 years; p = 0.04) and had longer cardiopulmonary bypass (118 ± 38 versus 85 ± 28 minutes; p < 0.001) and aortic cross-clamp times (33 ± 32 versus 14 ± 21 minutes; p < 0.001). There were no differences between groups regarding diagnosis, weight, hospital or intensive care unit length of stay, ventilator time, or 12-hour chest tube output. Postoperative complications were similar between groups, including bleeding (0 of 21 versus 8 of 215; p = 0.8), neurologic injury (1 of 21 versus 9 of 215; p = 0.7), arrhythmias (1 of 21 versus 24 of 215; p = 0.6), and operative mortality (0 of 21 versus 1 of 215; p = 0.1). Group 1 AVV regurgitation significantly decreased after surgery (3.0 ± 0.9 preoperatively versus 1.7 ± 0.9 postoperatively; p < 0.001).

Conclusions: Atrioventricular valve surgery has been shown to improve late outcomes for single-ventricle patients. This study demonstrates that AVV surgery performed with the Fontan procedure increased operative times, but did not significantly increase perioperative morbidity or mortality. This information supports appropriate utilization of AVV surgery for single-ventricle patients.