Effect of Earlier Atrioventricular Valve Intervention on Survival After the Fontan Operation
Section snippets
Methods
A retrospective review was performed of all patients in the Mayo Clinic Fontan database from January 1973 to February 2019. Permission was granted by the Institutional Review Board to perform this study. Data gathered included standard demographics, underlying anatomy, operative details, timing of first AVV intervention relative to Fontan, as well as long-term follow-up. Fontan connection type was based on the first Fontan operation in cases when patients underwent multiple Fontan revisions.
Results
Of the 1,167 patients in the database, 153 (13%) required AVV intervention throughout the stages of single ventricle palliation. Compared with patients who did not receive AVV intervention, those having intervention were more likely to have heterotaxy and unbalanced atrioventricular septal defect, but less likely to have double inlet left ventricle (Table 1). Those requiring AVV intervention were more likely to have a dominant right ventricle, a common AVV (CAVV), and less likely to have a
Discussion
The present study expands our knowledge of AVV disease in Fontan patients by examining the impact of timing of AVV intervention on outcomes. Similar to previous studies, we demonstrated a substantially increased risk of transplant and death among patients who undergo AVV intervention,2,5 with patients having a dominant right ventricle and CAVV at greatest risk for requiring AVV intervention. Importantly, whereas patients who had their first AVV intervention before Fontan were not at increased
Credit Author Statement
Stephens: Conceptualization, Methodology, Investigation, Formal Analysis, Writing (original draft, Review/editing).
Dearani: Conceptualization, Writing (Review/Editing).
Niaz: Conceptualization, Investigation.
Arghami: Methodology, Formal analysis.
Phillips: Investigation, Writing (Review/Editing).
Cetta: Conceptualization, Methodology, Investigation, Writing (original draft, Review/editing).
Declaration of Interests
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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2023, Canadian Journal of CardiologyCitation Excerpt :Although the current study suggests that earlier Fontan completion is associated with improved neurodevelopmental outcomes, further studies are required to confirm these findings and elucidate underlying mechanistic pathways. Previous work has demonstrated that AVV intervention at the time of Fontan completion is associated with increased morbidity and mortality in the post-Fontan period.31-33 To this end, there has been a shift in practice by some to preferentially address the AVV before completion of Fontan.31-34
Atrioventricular septal defect in Fontan circulation: Right ventricular dominance, not valve surgery, adversely affects survival
2023, Journal of Thoracic and Cardiovascular SurgeryPreoperative N-terminal pro-brain natriuretic peptide is associated with Fontan outcomes
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2022, Journal of the American College of CardiologyCitation Excerpt :As such, maintaining competency of the AVV is crucial, particularly in patients with RV dominance.17 AVV operation before or at Fontan completion has previously been identified as a risk factor for death or transplantation after Fontan operation.5-8 However, it is important to note that a disproportionate number of patients with RV dominance undergo AVV operation compared with patients with LV dominance.
Funding: None.