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

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.