Longevity and durability of atrioventricular valve repair in single-ventricle patients

Yasuhiro Kotani, Devin Chetan, Cori R. Atlin, Luc L. Mertens, Anusha Jegatheeswaran, Christopher A. Caldarone, Glen S. Van Arsdell, Osami Honjo

Research output: Contribution to journalArticle

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Abstract

Background: The durability of atrioventricular valve (AVV) repair and risk factors for recurrent AVV regurgitation (AVVR) and reintervention in single-ventricle patients are not well defined. Methods: Among 66 single-ventricle patients who underwent AVV repair between 1998 and 2011, 58 hospital survivors (88%) were retrospectively reviewed. Freedom from recurrent AVVR and reintervention were analyzed with Kaplan-Meier analysis. Predictors for recurrent AVVR, ventricular dysfunction, and reintervention were analyzed using regression analysis. Results: Significant (more than mild+) AVVR developed in 47 patients (81%) during mean follow-up of 37 months (range, 0.2 to 103 months). Freedom from significant AVVR was 23.8% at 1 year and 16.9% at 5 years. Reintervention was performed in 12 patients (26%) at a mean of 24 months (range, 2 to 64 months) after the initial repair. Freedom from reintervention was 92.3% at 1 year and 75.3% at 5 years. There were 11 late deaths (19%). Predictors for recurrent AVVR included repair at stage II (p = 0.020) and cardiopulmonary bypass time (p = 0.014). Predictors for reintervention included valvuloplasty as a repair technique (p = 0.013), cardiopulmonary bypass time (p = 0.002), aortic cross-clamp time (p = 0.003), and significant residual intraoperative AVVR (p = 0.012). Intraoperative ventricular dysfunction (p <0.001), aortic cross-clamp time (p = 0.005), and cleft as the mechanism of regurgitation (p = 0.023) predicted postrepair ventricular dysfunction. Conclusions: Although significant AVVR developed in most patients within 1 year of repair, the need for repeat valve repair is relatively low if ventricular function is preserved. Ventricular function after repair did not predict late survival but was related to the longevity of AVV competence and subsequent risk for reintervention.

Original languageEnglish
Pages (from-to)2061-2069
Number of pages9
JournalAnnals of Thoracic Surgery
Volume94
Issue number6
DOIs
Publication statusPublished - Dec 2012
Externally publishedYes

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Ventricular Dysfunction
Ventricular Function
Cardiopulmonary Bypass
Kaplan-Meier Estimate
Mental Competency
Survivors
Regression Analysis
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Kotani, Y., Chetan, D., Atlin, C. R., Mertens, L. L., Jegatheeswaran, A., Caldarone, C. A., ... Honjo, O. (2012). Longevity and durability of atrioventricular valve repair in single-ventricle patients. Annals of Thoracic Surgery, 94(6), 2061-2069. https://doi.org/10.1016/j.athoracsur.2012.04.048

Longevity and durability of atrioventricular valve repair in single-ventricle patients. / Kotani, Yasuhiro; Chetan, Devin; Atlin, Cori R.; Mertens, Luc L.; Jegatheeswaran, Anusha; Caldarone, Christopher A.; Van Arsdell, Glen S.; Honjo, Osami.

In: Annals of Thoracic Surgery, Vol. 94, No. 6, 12.2012, p. 2061-2069.

Research output: Contribution to journalArticle

Kotani, Y, Chetan, D, Atlin, CR, Mertens, LL, Jegatheeswaran, A, Caldarone, CA, Van Arsdell, GS & Honjo, O 2012, 'Longevity and durability of atrioventricular valve repair in single-ventricle patients', Annals of Thoracic Surgery, vol. 94, no. 6, pp. 2061-2069. https://doi.org/10.1016/j.athoracsur.2012.04.048
Kotani, Yasuhiro ; Chetan, Devin ; Atlin, Cori R. ; Mertens, Luc L. ; Jegatheeswaran, Anusha ; Caldarone, Christopher A. ; Van Arsdell, Glen S. ; Honjo, Osami. / Longevity and durability of atrioventricular valve repair in single-ventricle patients. In: Annals of Thoracic Surgery. 2012 ; Vol. 94, No. 6. pp. 2061-2069.
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abstract = "Background: The durability of atrioventricular valve (AVV) repair and risk factors for recurrent AVV regurgitation (AVVR) and reintervention in single-ventricle patients are not well defined. Methods: Among 66 single-ventricle patients who underwent AVV repair between 1998 and 2011, 58 hospital survivors (88{\%}) were retrospectively reviewed. Freedom from recurrent AVVR and reintervention were analyzed with Kaplan-Meier analysis. Predictors for recurrent AVVR, ventricular dysfunction, and reintervention were analyzed using regression analysis. Results: Significant (more than mild+) AVVR developed in 47 patients (81{\%}) during mean follow-up of 37 months (range, 0.2 to 103 months). Freedom from significant AVVR was 23.8{\%} at 1 year and 16.9{\%} at 5 years. Reintervention was performed in 12 patients (26{\%}) at a mean of 24 months (range, 2 to 64 months) after the initial repair. Freedom from reintervention was 92.3{\%} at 1 year and 75.3{\%} at 5 years. There were 11 late deaths (19{\%}). Predictors for recurrent AVVR included repair at stage II (p = 0.020) and cardiopulmonary bypass time (p = 0.014). Predictors for reintervention included valvuloplasty as a repair technique (p = 0.013), cardiopulmonary bypass time (p = 0.002), aortic cross-clamp time (p = 0.003), and significant residual intraoperative AVVR (p = 0.012). Intraoperative ventricular dysfunction (p <0.001), aortic cross-clamp time (p = 0.005), and cleft as the mechanism of regurgitation (p = 0.023) predicted postrepair ventricular dysfunction. Conclusions: Although significant AVVR developed in most patients within 1 year of repair, the need for repeat valve repair is relatively low if ventricular function is preserved. Ventricular function after repair did not predict late survival but was related to the longevity of AVV competence and subsequent risk for reintervention.",
author = "Yasuhiro Kotani and Devin Chetan and Atlin, {Cori R.} and Mertens, {Luc L.} and Anusha Jegatheeswaran and Caldarone, {Christopher A.} and {Van Arsdell}, {Glen S.} and Osami Honjo",
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AU - Kotani, Yasuhiro

AU - Chetan, Devin

AU - Atlin, Cori R.

AU - Mertens, Luc L.

AU - Jegatheeswaran, Anusha

AU - Caldarone, Christopher A.

AU - Van Arsdell, Glen S.

AU - Honjo, Osami

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N2 - Background: The durability of atrioventricular valve (AVV) repair and risk factors for recurrent AVV regurgitation (AVVR) and reintervention in single-ventricle patients are not well defined. Methods: Among 66 single-ventricle patients who underwent AVV repair between 1998 and 2011, 58 hospital survivors (88%) were retrospectively reviewed. Freedom from recurrent AVVR and reintervention were analyzed with Kaplan-Meier analysis. Predictors for recurrent AVVR, ventricular dysfunction, and reintervention were analyzed using regression analysis. Results: Significant (more than mild+) AVVR developed in 47 patients (81%) during mean follow-up of 37 months (range, 0.2 to 103 months). Freedom from significant AVVR was 23.8% at 1 year and 16.9% at 5 years. Reintervention was performed in 12 patients (26%) at a mean of 24 months (range, 2 to 64 months) after the initial repair. Freedom from reintervention was 92.3% at 1 year and 75.3% at 5 years. There were 11 late deaths (19%). Predictors for recurrent AVVR included repair at stage II (p = 0.020) and cardiopulmonary bypass time (p = 0.014). Predictors for reintervention included valvuloplasty as a repair technique (p = 0.013), cardiopulmonary bypass time (p = 0.002), aortic cross-clamp time (p = 0.003), and significant residual intraoperative AVVR (p = 0.012). Intraoperative ventricular dysfunction (p <0.001), aortic cross-clamp time (p = 0.005), and cleft as the mechanism of regurgitation (p = 0.023) predicted postrepair ventricular dysfunction. Conclusions: Although significant AVVR developed in most patients within 1 year of repair, the need for repeat valve repair is relatively low if ventricular function is preserved. Ventricular function after repair did not predict late survival but was related to the longevity of AVV competence and subsequent risk for reintervention.

AB - Background: The durability of atrioventricular valve (AVV) repair and risk factors for recurrent AVV regurgitation (AVVR) and reintervention in single-ventricle patients are not well defined. Methods: Among 66 single-ventricle patients who underwent AVV repair between 1998 and 2011, 58 hospital survivors (88%) were retrospectively reviewed. Freedom from recurrent AVVR and reintervention were analyzed with Kaplan-Meier analysis. Predictors for recurrent AVVR, ventricular dysfunction, and reintervention were analyzed using regression analysis. Results: Significant (more than mild+) AVVR developed in 47 patients (81%) during mean follow-up of 37 months (range, 0.2 to 103 months). Freedom from significant AVVR was 23.8% at 1 year and 16.9% at 5 years. Reintervention was performed in 12 patients (26%) at a mean of 24 months (range, 2 to 64 months) after the initial repair. Freedom from reintervention was 92.3% at 1 year and 75.3% at 5 years. There were 11 late deaths (19%). Predictors for recurrent AVVR included repair at stage II (p = 0.020) and cardiopulmonary bypass time (p = 0.014). Predictors for reintervention included valvuloplasty as a repair technique (p = 0.013), cardiopulmonary bypass time (p = 0.002), aortic cross-clamp time (p = 0.003), and significant residual intraoperative AVVR (p = 0.012). Intraoperative ventricular dysfunction (p <0.001), aortic cross-clamp time (p = 0.005), and cleft as the mechanism of regurgitation (p = 0.023) predicted postrepair ventricular dysfunction. Conclusions: Although significant AVVR developed in most patients within 1 year of repair, the need for repeat valve repair is relatively low if ventricular function is preserved. Ventricular function after repair did not predict late survival but was related to the longevity of AVV competence and subsequent risk for reintervention.

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