Abstract
Objective. The objective of the work is to present the results of the Fontan operation in patients with the pathology of atrioventricular valves.
Results. The follow-up period after surgery was 0.6–19 years (in the average – 4.7± 4.07 years). The patients were distributed into the following groups: group 1 was composed of 27 patients, group 2 – of 6 patients, group 3 – of 21 patients. Long-term mortality made up 14.8% and with the distribution by groups: group 1 – 11%, group 2 – 33%, group 3 – 14%. The cause of the majority of deaths in all the groups was circulatory insufficiency due to advanced atrioventricular regurgitation. Non-lethal complications occurred in 14% of cases, and they were caused by circulatory insufficiency in 75% of patients, by arrhythmia – in 25% of patients. The patients of all the groups showed the tendency of increasing grade of atrioventricular regurgitation: in group 1 – 30% of patients, group 2 – all the patients, group 3 – 15%. 88% of patients from group 1 and 89% of patients from group 3 were classified in NYHA Class I–II. 50% of patients from group 2 were placed in NYHA Class II. Long-term survival rates 5, 10 and 19 years after surgery were 80, 79 and 78% respectively, and by groups they were: in group 1 – 80% 19 years after operation, group 2 – 42% 16-year survival, group 3 – 72% 15-year survival. Survival rates with tricuspid and mitral valve regurgitation were 69 and 62% respectively, and with an open atrioventricular valve – 56%; survival rates in the patients with single left and single right ventricle were 69 and 52% respectively.
Conclusion: Systemic atrioventricular valve regurgitation of grade III–IV is a substantial risk factor for long-term mortality in patients after the Fontan operation and it requires timely surgery that will contribute to a reduction of long-term mortality and to an improvement of functional condition of patients.
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