Atrioventricular valve repair in patients with functional single-ventricle physiology: Impact of ventricular and valve function and morphology on survival and reintervention
Objective This study was to determine whether atrioventricular valve repair modifies natural history of single-ventricle patients with atrioventricular valve insufficiency and to identify factors predicting survival and reintervention. Methods Fifty-seven (13.5%) of 422 single-ventricle patients und...
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| creator | Honjo, Osami, MD, PhD Atlin, Cori R., BA Mertens, Luc, MD, PhD Al-Radi, Osman O., MD, MSc Redington, Andrew N., MD Caldarone, Christopher A., MD Van Arsdell, Glen S., MD |
| description | Objective This study was to determine whether atrioventricular valve repair modifies natural history of single-ventricle patients with atrioventricular valve insufficiency and to identify factors predicting survival and reintervention. Methods Fifty-seven (13.5%) of 422 single-ventricle patients underwent atrioventricular valve repair. Valve morphology, regurgitation mechanism, and ventricular morphology and function were analyzed for effect on survival, transplant, and reintervention with multivariate logistic and Cox regression models. Comparative analysis used case-matched controls. Results Atrioventricular valve was tricuspid in 67% and common in 28%. Ventricular morphology was right in 83%. Regurgitation mechanisms were prolapse (n = 24, 46%), dysplasia (n = 18, 35%), annular dilatation (n = 8, 15%), and restriction or cleft (n = 2, 4%). Postrepair insufficiency was none or trivial in 14 (26%), mild in 33 (61%), and moderate in 7 (13%). Survival in repair group was lower than in matched controls (78.9% vs 92.7% at 1 year, 68.7% vs 90.6% at 3 years, P = .015). Patients with successful repair and normal ventricular function had equivalent survival to matched controls ( P = .36). Independent predictors for death or transplant included increased indexed annular size ( P = .05), increased cardiopulmonary bypass time ( P = .04), and decreased postrepair ventricular function ( P = .01). Ventricular dilation was a time-related factor for all events, including failed repair. Conclusions Survival was lower in single-ventricle patients operated on for atrioventricular valve insufficiency than in case-matched controls. Patients with little postoperative residual regurgitation and preserved ventricular function had equivalent survival to controls. Lower grade ventricular function and ventricular dilation correlated with death and repair failure, suggesting that timing of intervention may affect outcome. |
| doi_str_mv | 10.1016/j.jtcvs.2010.11.060 |
| format | Article |
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Methods Fifty-seven (13.5%) of 422 single-ventricle patients underwent atrioventricular valve repair. Valve morphology, regurgitation mechanism, and ventricular morphology and function were analyzed for effect on survival, transplant, and reintervention with multivariate logistic and Cox regression models. Comparative analysis used case-matched controls. Results Atrioventricular valve was tricuspid in 67% and common in 28%. Ventricular morphology was right in 83%. Regurgitation mechanisms were prolapse (n = 24, 46%), dysplasia (n = 18, 35%), annular dilatation (n = 8, 15%), and restriction or cleft (n = 2, 4%). Postrepair insufficiency was none or trivial in 14 (26%), mild in 33 (61%), and moderate in 7 (13%). Survival in repair group was lower than in matched controls (78.9% vs 92.7% at 1 year, 68.7% vs 90.6% at 3 years, P = .015). Patients with successful repair and normal ventricular function had equivalent survival to matched controls ( P = .36). Independent predictors for death or transplant included increased indexed annular size ( P = .05), increased cardiopulmonary bypass time ( P = .04), and decreased postrepair ventricular function ( P = .01). Ventricular dilation was a time-related factor for all events, including failed repair. Conclusions Survival was lower in single-ventricle patients operated on for atrioventricular valve insufficiency than in case-matched controls. Patients with little postoperative residual regurgitation and preserved ventricular function had equivalent survival to controls. Lower grade ventricular function and ventricular dilation correlated with death and repair failure, suggesting that timing of intervention may affect outcome.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2010.11.060</identifier><identifier>PMID: 21592529</identifier><identifier>CODEN: JTCSAQ</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiopulmonary Bypass ; Cardiothoracic Surgery ; Case-Control Studies ; Child ; Child, Preschool ; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava ; Echocardiography ; Female ; Heart ; Heart Defects, Congenital - mortality ; Heart Defects, Congenital - physiopathology ; Heart Defects, Congenital - surgery ; Heart Ventricles - abnormalities ; Heart Ventricles - physiopathology ; Humans ; Infant ; Infant, Newborn ; Male ; Medical sciences ; Mitral Valve - physiopathology ; Mitral Valve - surgery ; Pneumology ; Postoperative Complications ; Reoperation ; Risk Factors ; Time Factors ; Treatment Outcome ; Tricuspid Valve - physiopathology ; Tricuspid Valve - surgery</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2011-08, Vol.142 (2), p.326-335.e2</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2011 The American Association for Thoracic Surgery</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c488t-56a77da1e503f45872febd44a2eca86b4e5b8763a69bba75a2fb2f2b831cffef3</citedby><cites>FETCH-LOGICAL-c488t-56a77da1e503f45872febd44a2eca86b4e5b8763a69bba75a2fb2f2b831cffef3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jtcvs.2010.11.060$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3548,27922,27923,45993</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24388295$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21592529$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Honjo, Osami, MD, PhD</creatorcontrib><creatorcontrib>Atlin, Cori R., BA</creatorcontrib><creatorcontrib>Mertens, Luc, MD, PhD</creatorcontrib><creatorcontrib>Al-Radi, Osman O., MD, MSc</creatorcontrib><creatorcontrib>Redington, Andrew N., MD</creatorcontrib><creatorcontrib>Caldarone, Christopher A., MD</creatorcontrib><creatorcontrib>Van Arsdell, Glen S., MD</creatorcontrib><title>Atrioventricular valve repair in patients with functional single-ventricle physiology: Impact of ventricular and valve function and morphology on survival and reintervention</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objective This study was to determine whether atrioventricular valve repair modifies natural history of single-ventricle patients with atrioventricular valve insufficiency and to identify factors predicting survival and reintervention. Methods Fifty-seven (13.5%) of 422 single-ventricle patients underwent atrioventricular valve repair. Valve morphology, regurgitation mechanism, and ventricular morphology and function were analyzed for effect on survival, transplant, and reintervention with multivariate logistic and Cox regression models. Comparative analysis used case-matched controls. Results Atrioventricular valve was tricuspid in 67% and common in 28%. Ventricular morphology was right in 83%. Regurgitation mechanisms were prolapse (n = 24, 46%), dysplasia (n = 18, 35%), annular dilatation (n = 8, 15%), and restriction or cleft (n = 2, 4%). Postrepair insufficiency was none or trivial in 14 (26%), mild in 33 (61%), and moderate in 7 (13%). Survival in repair group was lower than in matched controls (78.9% vs 92.7% at 1 year, 68.7% vs 90.6% at 3 years, P = .015). Patients with successful repair and normal ventricular function had equivalent survival to matched controls ( P = .36). Independent predictors for death or transplant included increased indexed annular size ( P = .05), increased cardiopulmonary bypass time ( P = .04), and decreased postrepair ventricular function ( P = .01). Ventricular dilation was a time-related factor for all events, including failed repair. Conclusions Survival was lower in single-ventricle patients operated on for atrioventricular valve insufficiency than in case-matched controls. Patients with little postoperative residual regurgitation and preserved ventricular function had equivalent survival to controls. Lower grade ventricular function and ventricular dilation correlated with death and repair failure, suggesting that timing of intervention may affect outcome.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiopulmonary Bypass</subject><subject>Cardiothoracic Surgery</subject><subject>Case-Control Studies</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava</subject><subject>Echocardiography</subject><subject>Female</subject><subject>Heart</subject><subject>Heart Defects, Congenital - mortality</subject><subject>Heart Defects, Congenital - physiopathology</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Heart Ventricles - abnormalities</subject><subject>Heart Ventricles - physiopathology</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mitral Valve - physiopathology</subject><subject>Mitral Valve - surgery</subject><subject>Pneumology</subject><subject>Postoperative Complications</subject><subject>Reoperation</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Tricuspid Valve - physiopathology</subject><subject>Tricuspid Valve - surgery</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFktGK1DAUhoMo7uzqEwiSG_GqY5I2bSooLMuqCwteqOBdSNOTndRMU5O2Mg_lO5rOdFW88erAOd__55D_IPSMki0ltHzVbbtRz3HLyNKhW1KSB2hDSV1lpeBfH6INIYxlnLH8DJ3H2BFCKkLrx-iMUV4zzuoN-nk5Butn6FPRk1MBz8rNgAMMygZsezyo0aZxxD_suMNm6vVofa8cjra_c5CtWgd42B2i9c7fHV7jm_2g9Ii9wX97q75d_e99jq29D8PuKMSpE6cw20QdRwFsP0JYTBL9BD0yykV4utYL9OXd9eerD9ntx_c3V5e3mS6EGDNeqqpqFQVOclNwUTEDTVsUioFWomwK4I2oylyVddOoiitmGmZYI3KqjQGTX6CXJ98h-O8TxFHubdTgnOrBT1GKSpC84EWVyPxE6uBjDGDkEOxehYOkRC4xyU4eY5JLTJJSmWJKquer_9Tsof2tuc8lAS9WQEWtnAmq1zb-4YpcCFbzxL05cZB-Y7YQZNQpLQ2tDaBH2Xr7n0Xe_qPXzvY2PfkNDhA7P4UUdZRURiaJ_LRc1HJQlBJSUEbyX5d5zY4</recordid><startdate>20110801</startdate><enddate>20110801</enddate><creator>Honjo, Osami, MD, PhD</creator><creator>Atlin, Cori R., BA</creator><creator>Mertens, Luc, MD, PhD</creator><creator>Al-Radi, Osman O., MD, MSc</creator><creator>Redington, Andrew N., MD</creator><creator>Caldarone, Christopher A., MD</creator><creator>Van Arsdell, Glen S., MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20110801</creationdate><title>Atrioventricular valve repair in patients with functional single-ventricle physiology: Impact of ventricular and valve function and morphology on survival and reintervention</title><author>Honjo, Osami, MD, PhD ; Atlin, Cori R., BA ; Mertens, Luc, MD, PhD ; Al-Radi, Osman O., MD, MSc ; Redington, Andrew N., MD ; Caldarone, Christopher A., MD ; Van Arsdell, Glen S., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c488t-56a77da1e503f45872febd44a2eca86b4e5b8763a69bba75a2fb2f2b831cffef3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cardiopulmonary Bypass</topic><topic>Cardiothoracic Surgery</topic><topic>Case-Control Studies</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava</topic><topic>Echocardiography</topic><topic>Female</topic><topic>Heart</topic><topic>Heart Defects, Congenital - mortality</topic><topic>Heart Defects, Congenital - physiopathology</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Heart Ventricles - abnormalities</topic><topic>Heart Ventricles - physiopathology</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mitral Valve - physiopathology</topic><topic>Mitral Valve - surgery</topic><topic>Pneumology</topic><topic>Postoperative Complications</topic><topic>Reoperation</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Tricuspid Valve - physiopathology</topic><topic>Tricuspid Valve - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Honjo, Osami, MD, PhD</creatorcontrib><creatorcontrib>Atlin, Cori R., BA</creatorcontrib><creatorcontrib>Mertens, Luc, MD, PhD</creatorcontrib><creatorcontrib>Al-Radi, Osman O., MD, MSc</creatorcontrib><creatorcontrib>Redington, Andrew N., MD</creatorcontrib><creatorcontrib>Caldarone, Christopher A., MD</creatorcontrib><creatorcontrib>Van Arsdell, Glen S., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Honjo, Osami, MD, PhD</au><au>Atlin, Cori R., BA</au><au>Mertens, Luc, MD, PhD</au><au>Al-Radi, Osman O., MD, MSc</au><au>Redington, Andrew N., MD</au><au>Caldarone, Christopher A., MD</au><au>Van Arsdell, Glen S., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Atrioventricular valve repair in patients with functional single-ventricle physiology: Impact of ventricular and valve function and morphology on survival and reintervention</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2011-08-01</date><risdate>2011</risdate><volume>142</volume><issue>2</issue><spage>326</spage><epage>335.e2</epage><pages>326-335.e2</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><coden>JTCSAQ</coden><abstract>Objective This study was to determine whether atrioventricular valve repair modifies natural history of single-ventricle patients with atrioventricular valve insufficiency and to identify factors predicting survival and reintervention. Methods Fifty-seven (13.5%) of 422 single-ventricle patients underwent atrioventricular valve repair. Valve morphology, regurgitation mechanism, and ventricular morphology and function were analyzed for effect on survival, transplant, and reintervention with multivariate logistic and Cox regression models. Comparative analysis used case-matched controls. Results Atrioventricular valve was tricuspid in 67% and common in 28%. Ventricular morphology was right in 83%. Regurgitation mechanisms were prolapse (n = 24, 46%), dysplasia (n = 18, 35%), annular dilatation (n = 8, 15%), and restriction or cleft (n = 2, 4%). Postrepair insufficiency was none or trivial in 14 (26%), mild in 33 (61%), and moderate in 7 (13%). Survival in repair group was lower than in matched controls (78.9% vs 92.7% at 1 year, 68.7% vs 90.6% at 3 years, P = .015). Patients with successful repair and normal ventricular function had equivalent survival to matched controls ( P = .36). Independent predictors for death or transplant included increased indexed annular size ( P = .05), increased cardiopulmonary bypass time ( P = .04), and decreased postrepair ventricular function ( P = .01). Ventricular dilation was a time-related factor for all events, including failed repair. Conclusions Survival was lower in single-ventricle patients operated on for atrioventricular valve insufficiency than in case-matched controls. Patients with little postoperative residual regurgitation and preserved ventricular function had equivalent survival to controls. Lower grade ventricular function and ventricular dilation correlated with death and repair failure, suggesting that timing of intervention may affect outcome.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>21592529</pmid><doi>10.1016/j.jtcvs.2010.11.060</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cardiology. Vascular system Cardiopulmonary Bypass Cardiothoracic Surgery Case-Control Studies Child Child, Preschool Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava Echocardiography Female Heart Heart Defects, Congenital - mortality Heart Defects, Congenital - physiopathology Heart Defects, Congenital - surgery Heart Ventricles - abnormalities Heart Ventricles - physiopathology Humans Infant Infant, Newborn Male Medical sciences Mitral Valve - physiopathology Mitral Valve - surgery Pneumology Postoperative Complications Reoperation Risk Factors Time Factors Treatment Outcome Tricuspid Valve - physiopathology Tricuspid Valve - surgery |
| title | Atrioventricular valve repair in patients with functional single-ventricle physiology: Impact of ventricular and valve function and morphology on survival and reintervention |
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