Document Detail


Perioperative risks and outcomes of atrioventricular valve surgery in conjunction with Fontan procedure.
MedLine Citation:
PMID:  19379889     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Faraz Kerendi; Zachary B Kramer; William T Mahle; Brian E Kogon; Kirk R Kanter; Paul M Kirshbom
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  87     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-21     Completed Date:  2009-05-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1484-8; discussion 1488-9     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
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MeSH Terms
Descriptor/Qualifier:
Child
Child, Preschool
Coronary Artery Bypass / methods*,  mortality
Female
Fontan Procedure / methods,  mortality*
Heart Valve Diseases / surgery*
Heart Valve Prosthesis Implantation / methods,  mortality*
Humans
Infant
Intensive Care Units
Intraoperative Complications / epidemiology*
Length of Stay
Male
Perioperative Care*
Postoperative Complications / classification,  epidemiology
Retrospective Studies
Risk Factors
Treatment Outcome
Tricuspid Valve / surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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