Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany.
Department of Cardiovascular Surgery, Insure (Institute for Translational Cardiac Surgery), German Heart Centre Munich at the Technical University of Munich, Munich, Germany.
Cardiol Young. 2024 Jul;34(7):1554-1562. doi: 10.1017/S104795112400012X. Epub 2024 Apr 3.
Atrioventricular valve regurgitation in patients with univentricular heart is a well-known risk factor for adverse outcomes and atrioventricular valve repair remains a particular surgical challenge.
We reviewed all surgical atrioventricular valve procedures in patients with univentricular heart and two separate atrioventricular valves who underwent surgical palliation. Endpoints of the study were reoperation-free survival and cumulative incidence of reoperation.
Between 1994 and 2021, 202 patients with univentricular heart and two separate atrioventricular valve morphology underwent surgical palliation, with 15.8% (32/202) requiring atrioventricular valve surgery. Primary diagnoses were double inlet left ventricle (n = 14, 43.8%), double outlet right ventricle (n = 7, 21.9%), and congenitally corrected transposition of the great arteries (n = 7, 21.9%). Median weight at valve surgery was 10.6 kg (interquartile range, 7.9-18.9). Isolated left or right atrioventricular valve surgery was required in nine (28.1%) and 22 patients (68.8%), respectively. Concomitant left and right atrioventricular valve surgery was performed in one patient (3.1%). Closure of the left valve was conducted in four patients (12.5%) and closure of the right valve in three (9.4%). Operative and late mortality were 3.1% and 9.7%, respectively. Reoperation-free survival and cumulative incidence of reoperation at 10 years after surgery were 62.3% (standard error of the mean: 6.9) and 30.9% (standard error of the mean: 9.6), respectively.
In patients with univentricular heart and two separate atrioventricular valves, surgical intervention on these valves is required in a minority of patients and is associated with low mortality but high incidence of reoperation.
单心室患者的房室瓣反流是不良预后的一个众所周知的危险因素，而房室瓣修复仍然是一项特殊的手术挑战。
我们回顾了所有在接受单心室心脏和两个独立房室瓣的患者中进行的手术房室瓣手术，这些患者接受了手术姑息治疗。研究的终点是无再手术生存率和再手术累积发生率。
1994 年至 2021 年间，202 例单心室心脏和两个独立房室瓣形态的患者接受了手术姑息治疗，其中 15.8%（32/202）需要房室瓣手术。主要诊断为双入口左心室（n=14，43.8%）、双出口右心室（n=7，21.9%）和先天性矫正性大动脉转位（n=7，21.9%）。瓣膜手术时的中位体重为 10.6 公斤（四分位距，7.9-18.9）。9 例（28.1%）和 22 例（68.8%）分别需要单独的左或右房室瓣手术。1 例（3.1%）行左、右房室瓣联合手术。4 例（12.5%）行左瓣关闭术，3 例（9.4%）行右瓣关闭术。手术和晚期死亡率分别为 3.1%和 9.7%。手术后 10 年无再手术生存率和再手术累积发生率分别为 62.3%（均数标准差：6.9）和 30.9%（均数标准差：9.6）。
在单心室心脏和两个独立房室瓣的患者中，只有少数患者需要对这些瓣膜进行手术干预，手术死亡率低，但再手术发生率高。
