Background: Significant atrioventricular valve (AVV) insufficiency has been associated with increased mortality and morbidity in Fontan candidates. The outcomes of patients undergoing AVV repair during Fontan palliation were reviewed to determine the optimal technique and timing of repair.
METHODS: We retrospectively reviewed our experience with AVV repair in Fontan candidates from July 2004 to June 2008.
RESULTS: Of the 15 first-time AVV repairs (8 Tricuspid valves, 7 common AV valves), 3 were performed in neonates, 7 at bidirectional Glenn, 1 at fenestrated Kawashima in 3-month-old infant, 2 after Glenn and 2 at Fontan. The median age at the first AVV repair was 11 (0.1-131) months. Edge to edge repair was performed in 9 patients and semicircular annuloplasty in 6. As additional procedures, Norwood (1), primary sutureless repair of TAPVC (1) and PA plasty with RV-PA shunt (1) were performed respectively in 3 neonates. Preoperatively, the median echocardiographic severity of AVV regurgitation was grade 3 (range: 2-4). At median follow up of 30 months (5-52 months) the severity of AVV regurgitation was reduced significantly to median grade 2 (range: 2-3; p <0.001). Six patients required a reoperation for AVV regurgitation; 1 at Glenn, 3 pre-Fontan, 2 at Fontan. Thereafter, 3 of them required AVV replacement. There were no operative death and one late death arising from pulmonary venous obstruction. Eleven of 14 survivors have completed Fontan with no early and no late deaths.
CONCLUSION: Aggressive treatment of concomitant AVV insufficiency since neonatal period contributes to improved outcome.