Atrioventricular valve replacement in patients with a single ventricle

Background. Significant atrioventricular valve (AW) insufficiency has been associated with increased mortality and morbidity in patients with single v entricle. Although many patients can be managed with valvuloplasty alone, s ome patients require AW replacement. The optimal timing outcome, and risk f actors for AW replacement in this population have not been described. Methods. We retrospectively reviewed our experience with AVV replacement in patients with single ventricle from January 1984 to August 2000. Outcome v ariables included mortality and valve-related complications. Results. Seventeen patients required AVV replacement. Prosthetic valve type s included: St. Jude's valve in 14, Bjork-Shiley in 1, Hall-Kaster in 1, an d Carpentier-Edwards in 1. Valve size ranged from 17 to 33 mm. Median age a t valve replacement was 3.0 years (range 7 days to 17.3 years). Of the 16 s ubjects with normal atrioventricular conduction preoperatively, 7 (44%) dev eloped postoperative complete heart block. Hospital mortality was 29%. Hosp ital mortality decreased significantly from 56% in 1984 to 1993 to no death s from 1994 to 2000 (p = 0.03). Younger age (less than 2 years) at operatio n was also a risk factor for hospital mortality (p = 0.03). There were four late deaths irl this series and 1 patient underwent heart transplantation, Of the surviving patients, none has required replacement of the prosthetic valve. No patients have had cerebrovascular accident subsequent to AVV rep lacement. Functional status is New York Heart Association functional class I in 5, class II in 1, and Class III in 1. Conclusions. Atrioventricular valve replacement can be performed in patient s with single ventricle with acceptable morbidity and mortality. The develo pment of postoperative complete heart block is common. Survival after AW re placement has improved in recent years, and intervention before patients de velop ventricular dysfunction and atrial arrhythmias may further improve ou tcome. (C) 2001 by The Society of Thoracic Surgeons.