Long-term Results of Modified Fontan Operation for Single Ventricular Patients Associated with Atrioventricular Valve Regurgitation

  • Dr Yuji Naito, Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Japan
  • Dr Yasuharu Imai, Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Japan
  • Dr Kazuaki Ishihara, Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Japan
  • Dr Takeshi Hiramatsu, Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Japan
  • Dr Kouta Agematsu, Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Japan
  • Dr Masaki Sasoh, Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Japan
  • Prof Toshio Nakanishi, Department of Pediatric Cardiology, Heart Institute of Japan, Tokyo Women's Medical University, Japan
  • Prof Hiromi Kurosawa, Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Japan

    • Objective:To examine the long-term outcome of modified Fontan operation (mFO) concomitant with valve surgery against atrioventricular valve (AVV) regurgitation.

    Patients and Methods:We retrospectively reviewed 555 children (median 6.2 years) who underwent mFO between 1974 and 2003, and they were subdivided into group P (With AVV plasty, n=210) and group N (Without AVV plasty, n=345).

    Results:Significantly higher proportion of patients have heterotaxic heart in group P (Group P vs N: 48% vs 15%, p<0.01), and the common AVV were significantly prevalent in group P (49% vs 14%, p<0.01). Preoperative grading of AVV regurgitation was significantly higher in group P (1.7 vs 0.1, p<0.01). Surgical techniques to correct valve incompetence included circular annuloplasty, unilateral valve closure, annuloplasty with Kaye-Reed methods, and edge-to-edge repair methods, which were combined according to the etiology of lesion. There were 24 and 13 hospital deaths, plus 20 and 35 late deaths in group P and N, respectively. Actuarial survival were 82.1% and 75.8% in group P, and 90.0% and 81.2% in group N (p<0.05) at 10 and 20 years, respectively. Freedom from re-intervention including all reoperation and balloon angioplasty for pulmonary stenosis were 86.1% and 74.1% in group P, and 89.5% and 79.8% in group N (N.S.) at 10 and 20 years, respectively. Long-term survivor showed acceptable valve competence, and long-term BNP concentrations were comparable in both groups (mean 84 vs 95 pg/ml).

    Conclusion:Single ventricular patients with AVV regurgitation showed acceptable long-term result with no progression of lesion However, further improvement of valve surgery is required.