초록접수 현황
| 16F-188 | 구연 발표 |
Outcomes of Atrioventricular Valve Repair for Children with Functionally Single ventricle
Jong Yoon Park, Won Kyoun Park, Chun Soo Park, Jeong-Jun Park, Tae-Jin Yun
Department of Pediatric Cardiac Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
Background : Atrioventricular valve(AVV) regurgitation imposes a significant burden on the single ventricle hemodynamics. We sought to determine the outcome of AVV repair in children with functionally single ventricle(FSV).
Methods : Retrospective review was conducted for 33 patients with FSV(19 males) who underwent AVV repair between 2000 and 2016. AVV morphology was common in 8, tricuspid atresia in 2, and mitral atresia in 9. Heterotaxy syndrome was associated in 7 patients, TAPVC in 3, and ventricular morphology was LV in 5, RV in 18, balanced in 10. Timing of AVV repair was pre-bidirectional Glenn shunt (BDG) in 9, at BDG in 12, upon Fontan procedure in 7, and post-Fontan in 5. Overall survival and composite outcome (freedom from death, valve replacement, and recurrence of significant AVV regurgitation) were assessed, and risk factors for decreased time to adverse composite outcome were analyzed.
Results : Early mortality after AVV repair occurred in 3 patients(3/33, 9.1%). During the median follow-up duration of 54 months(range:0-188), 6 patients underwent AVV replacement using mechanical prosthetic valve and 15 patients developed significant recurrent AVV regurgitation on echocardiography. Overall survival at 5 years was 73.3%, and freedom from death, AVV replacement, or recurrence of significant AVV regurgitation at 1,2, and 3 years were 47.8%, 43.9 %, and 35.4%. On Cox proportional Hazards model, association of right atrial isomerism(HR:4.71,95% CI:1.09-20.21 P=0.037) and AVV repair before BDG(HR:2.47, 95% CI:0.99-6.11 P=0.05) were associated with deceased time to adverse composite outcomes.
Conclusion : Outcomes of AVV repair for children with FSV are less than optimal and late clinical deteriorations occurred in patients with successful immediate AVV repair. Therefore, early AVV replacement may lead to a better outcome for selected patients.
Methods : Retrospective review was conducted for 33 patients with FSV(19 males) who underwent AVV repair between 2000 and 2016. AVV morphology was common in 8, tricuspid atresia in 2, and mitral atresia in 9. Heterotaxy syndrome was associated in 7 patients, TAPVC in 3, and ventricular morphology was LV in 5, RV in 18, balanced in 10. Timing of AVV repair was pre-bidirectional Glenn shunt (BDG) in 9, at BDG in 12, upon Fontan procedure in 7, and post-Fontan in 5. Overall survival and composite outcome (freedom from death, valve replacement, and recurrence of significant AVV regurgitation) were assessed, and risk factors for decreased time to adverse composite outcome were analyzed.
Results : Early mortality after AVV repair occurred in 3 patients(3/33, 9.1%). During the median follow-up duration of 54 months(range:0-188), 6 patients underwent AVV replacement using mechanical prosthetic valve and 15 patients developed significant recurrent AVV regurgitation on echocardiography. Overall survival at 5 years was 73.3%, and freedom from death, AVV replacement, or recurrence of significant AVV regurgitation at 1,2, and 3 years were 47.8%, 43.9 %, and 35.4%. On Cox proportional Hazards model, association of right atrial isomerism(HR:4.71,95% CI:1.09-20.21 P=0.037) and AVV repair before BDG(HR:2.47, 95% CI:0.99-6.11 P=0.05) were associated with deceased time to adverse composite outcomes.
Conclusion : Outcomes of AVV repair for children with FSV are less than optimal and late clinical deteriorations occurred in patients with successful immediate AVV repair. Therefore, early AVV replacement may lead to a better outcome for selected patients.
책임저자: Tae-Jin Yun
Department of Pediatric Cardiac Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
발표자: Jong Yoon Park, E-mail : enthusiasmchad@gmail.com