Edge-to-edge repair of common atrioventricular or tricuspid valve in patients with functionally single ventricle.

BACKGROUND: There is a limitation to the ability of the tricuspid or common atrioventricular valve to function in the systemic position, and insufficiency of these valves often carries an important risk during the staged surgical reconstruction in single ventricle. The purpose of this study was to assess the efficacy of edge-to-edge repair, involving suturing of the free-floating segments of the opposing leaflets, applied in this context.

METHODS: Between 1989 and 2006, 49 patients with tricuspid or common atrioventricular valve regurgitation (moderate or greater) associated with single ventricle underwent valve repair 53 times. Edge-to-edge repair was performed in 5 of 23 with tricuspid valve and 17 of 30 with common atrioventricular valve.

RESULTS: In the edge-to-edge group, more patients had severe regurgitation (59.1%) compared with the non-edge-to-edge group (32.3%) before operation (p = 0.0906). The postoperative degree of regurgitation was mild or less in 95.5% of the edge-to-edge group compared with 48.4% of the non-edge-to-edge group (p = 0.0003). Tricuspid or atrioventricular valve stenosis was not observed in any of the patients after repair. The degree of regurgitation on follow-up echocardiogram was mild or less in 77.3% of the edge-to-edge group at 2.6 +/- 4.0 years after repair, compared with 38.7% of the non-edge-to-edge group at 1.9 +/- 3.2 years (p = 0.109).

CONCLUSIONS: Edge-to-edge repair was an effective adjunctive in repairing tricuspid or common atrioventricular valve associated with functionally single ventricle. An excellent reduction of regurgitation was observed in most of the patients, and may lead to preservation of ventricular function during interim stage and successful completion of the Fontan operation.