Thirty years of left atrioventricular valve reoperations following atrioventricular septal defect repair: Impact of valvar stenosis.

Abstract

The most frequent reason for reoperation after an index atrioventricular septal defect (AVSD) repair is left atrioventricular valve (LAVV) dysfunction. LAVV stenosis (LAVVS), although less common than regurgitation, may be a more problematic lesion to repair. We sought to identify baseline LAVV anatomic characteristics and outcomes associated with both LAVV reoperation overall and LAVVS in particular. A retrospective review was conducted of patients who underwent a biventricular index AVSD repair between January 1995 and August 2024. All AVSD subtypes were included. Univariate and multivariate Fine-Gray analyses were performed, with Kaplan-Meier estimates with log-rank used for survival analysis. A total of 838 patients underwent an index AVSD, of whom 82 underwent at least 1 LAVV reoperation. Multivariate Fine-Gray analysis demonstrated that short chordae, hypoplastic inferior bridging leaflets, double-orifice LAVV, left ventricular outflow tract obstruction repair, and aortic arch repair were significantly associated with LAVV reoperations in general (P ≤ .01), while univariate competing-risks analysis identified subvalvar malformations as the most significant risk factors for LAVV reoperations for stenosis (P = .0001). The 6-year replacement-free survival for patients who underwent reoperation for LAVVS and LAVV regurgitation was 16.1% and 86.8%, respectively. Patients with subvalvar malformations were at significantly higher risk for LAVV reoperation due to stenosis. Most patients who developed LAVVS ultimately required valve replacement within the first 5 years after index AVSD repair and had significantly worse actuarial survival compared to those who only underwent LAVV reoperation for isolated regurgitation.