Short-term Outcomes of Adjustable Annular Bridging Technique for Common Atrioventricular Valve Regurgitation in Patients with Single Ventricle

H. Suzuki¹, Y. Kotani², J. Kobayashi², Y. Fujii², T. Kawabata², G. Kato², Y. Kuroko², S. Kasahara^2
1Okayama University, Okayama Japan, Okayama ²Okayama University, Okayama, Okayama

Purpose: Common atrioventricular valve (CAVV) regurgitation is associated with worse prognosis in patients undergoing staged Fontan operation. Various techniques have been previously described; however, CAVV repair remains technically challenging. This study aimed to investigate the short-term outcomes of adjustable annular bridging technique in patients with CAVV regurgitation.

Methods:

Methods: Retrospective chart review was performed in single-ventricle patients who had CAVV repair from January 2010 to July 2023. For adjustable annular bridging technique, an ePTFE vascular suture was applied to fix the length of the anteroposterior dimension against the atrial dilatation. Using the tourniquet, the size of the valve orifice was adjusted by guidance of a regurgitation test. We defined patients who underwent adjustable annular bridging technique (±combined with other technique) as Group A and valve repair without adjustable annular bridging technique as Group C. Patients who previously had a valve repair other than adjustable annular bridging technique were also included. The severity of regurgitation was rated by echocardiography as none=0, mild=1, moderate=2, severe=3.

Results: Forty-six patients (Group A: n=17(37%); Group C: n=29(63%)) underwent valvuloplasty for CAVV regurgitation. Median age was 11.5 (IQR, 7-34) months. There were 33 patients with Heterotaxy (asplenia: n=30, polysplenia: n=3). The CAVV regurgitation immediately after surgery was mild in 12 patients (70%), moderate in 5 patients(30%) in group A and none in 6 patients(20%), mild in 18 patients(62%), and moderate in 5 patients(17%) in group C. The median follow-up period was 2.3 (IQR, 0.6–7.5) years. The severity of CAVV regurgitation was unchanged in Group A (-0.11±0.85) but was worsened in Group C (0.75±0.78) (P=0.001). As a result, the severity of regurgitation grade at the latest follow-up (or before re-intervention) was 1.41±0.21 in Group A and 1.96±0.16 in Group C (p=0.042). In total, 21 valve re-interventions (18 CAVV plasty and 3 valve replacement) were performed in 15 out of 46 patients (33%). Re-intervention was more required in Group C compared to Group A (13 patients (44%) vs. 2 patients (12%), p=0.021). Patients who achieved Fontan completion and awaiting Fontan completion were comparable between the two groups. (Group A: 71% vs. Group C: 59%, p=0.149) There was no significant difference in survival rate between the two groups by the K-M method (p=0.794).

Conclusion:

Conclusion: Adjustable annular bridging technique vs. conventional repair resulted in favorable short-term outcomes by maintaining CAVV competence.

Identify the source of the funding for this research project: N/A