Outcomes of atrioventricular valve interventions in patients with univentricular heart

Mariel L. Foti, Cardiology Service, Hospital J. P. Garrahan, Buenos Aires, Argentina
Erica V. Stelmaszewski, Cardiology Service, Hospital J. P. Garrahan, Buenos Aires, Argentina
D. Mariela Mouratian, Cardiology Service, Hospital J. P. Garrahan, Buenos Aires, Argentina
Ayda R. Muñoz-Lorduy, Cardiology Service, Hospital J. P. Garrahan, Buenos Aires, Argentina
Jessica K. Moreno-Castillo, Cardiology Service, Hospital J. P. Garrahan, Buenos Aires, Argentina
Gladys Salgado, Cardiology Service, Hospital J. P. Garrahan, Buenos Aires, Argentina
M. Victoria Lafuente, Cardiology Service, Hospital J. P. Garrahan, Buenos Aires, Argentina

Objective: To analyze the outcomes and risk factors in patients who required intervention on AVV. Atrioventricular valve (AVV) failure in the single ventricle is a complication in follow-up. Method: Single-center retrospective study of patients with univentricular heart who required intervention on AVV. Results: We included 69 patients between 1991 and 2022 with AVV intervention, mean follow-up of 7.1 years. AVV repair: in 50 patients, leaving 50% without AVV regurgitation (AVVR) or with mild AVVR. In the long follow-up, 18 patients (42%) presented moderate AVVR, and 5 patients (12%) severe AVVR. Ten patients required reoperation. In the univariate analysis, the risk factors were pre-operative ventricular dysfunction (p = 0.015), right ventricular morphology (p = 0.006), and common AVV (p = 0.003). In multivariate, the independent predictor of risk was common AVV (p = 0.007). The estimated overall survival was 84% at 1 year (95% confidence interval [CI] 70-91), 77% at 5 years (95% CI 62-86), and 61% at 20 years (95% CI 42-76). AVV replacement: at 2 patients with dextroisomerism and at follow-up 4 patients.AVV closure: 17 patients, effective 14 patients, 3 patients required re-closing. Conclusion: The success of AVV interventionis related to the initial anatomy and type of AVV. Risk factors for ineffective repair were pre-operative ventricular dysfunction,dominant right ventricle, and common AVV. Common AVV was the only risk predictor for ineffective repair.

Keywords: Atrioventricular valve. Atrioventricular valve repair. Univentricular heart. Single ventricle. Fontan. Glenn.