Late results of systemic atrioventricular valve replacement in corrected transposition

Jacques A M van Son, Gordon K. Danielson, James C. Huhta, Carole A. Warnes, William D. Edwards, Hartzell V Schaff, Francisco J. Puga, Duane M. Ilstrup

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Abstract

From December 1964 to October 1993, 40 patients (aged 5 months to 70 years, mean 21.8 years, median 13.6 years) with corrected transposition and systemic atrioventricular valve insufficiency underwent replacement ( n = 39) or repair ( n = 1) of the systemic atrioventricular valve. Thirty-nine patients had situs solitus and 1 had situs inversus. Associated anomalies included Ebstein's malformation of the systemic atrioventricular valve ( n = 22), ventricular septal defect ( n = 19), and pulmonary stenosis ( n = 14). Preoperatively, 16 patients (40.0%) had complete heart block and 27 patients (67.5%) were in New York Heart Association functional classes III and IV. The early mortality was 10.0% ( n = 4) and 8 patients died subsequently. The principal cause of death in all 12 patients was systemic ventricular failure. Overall survival including early mortality was 78.0% at 5 years and 60.7% at 10 years; survival excluding early mortality was 86.7% at 5 years and 67.5% at 10 years. Survivorship correlated with preoperative systemic ventricular ejection fraction of 44% or more ( p < 0.001) and later interval of operation (9 deaths in 15 patients before 1981 versus 3 deaths in 25 patients subsequently) ( p = 0.06). There were no cases of surgically induced complete heart block. Two patients underwent late reoperations related to the systemic atrioventricular valve prosthesis. Follow-up extended to 26.0 years (median 4.7 years). At last follow-up, 18 of the 28 survivors were in New York Heart Association functional class I, 9 were in class II, and 1 was in class III. We conclude that the results of systemic atrioventricular valve replacement in corrected transposition have improved significantly during the past decade. To preserve systemic ventricular function, we suggest operation be considered at the earliest sign of progressive ventricular dysfunction as assessed by serial clinical evaluation and echocardiography. (J THORAC CARDIOVASC SURG 1995;109:642-53).

Original languageEnglish (US)
Pages (from-to)642-653
Number of pages12
JournalThe Journal of Thoracic and Cardiovascular Surgery
Volume109
Issue number4
DOIs
StatePublished - 1995

Fingerprint

Heart Block
Mortality
Ebstein Anomaly
Situs Inversus
Ventricular Dysfunction
Pulmonary Valve Stenosis
Survival
Ventricular Function
Ventricular Heart Septal Defects
Reoperation
Stroke Volume
Prostheses and Implants
Survivors
Echocardiography
Cause of Death
Survival Rate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Late results of systemic atrioventricular valve replacement in corrected transposition. / van Son, Jacques A M; Danielson, Gordon K.; Huhta, James C.; Warnes, Carole A.; Edwards, William D.; Schaff, Hartzell V; Puga, Francisco J.; Ilstrup, Duane M.

In: The Journal of Thoracic and Cardiovascular Surgery, Vol. 109, No. 4, 1995, p. 642-653.

Research output: Contribution to journalArticle

van Son, JAM, Danielson, GK, Huhta, JC, Warnes, CA, Edwards, WD, Schaff, HV, Puga, FJ & Ilstrup, DM 1995, 'Late results of systemic atrioventricular valve replacement in corrected transposition', The Journal of Thoracic and Cardiovascular Surgery, vol. 109, no. 4, pp. 642-653. https://doi.org/10.1016/S0022-5223(95)70345-4
van Son, Jacques A M ; Danielson, Gordon K. ; Huhta, James C. ; Warnes, Carole A. ; Edwards, William D. ; Schaff, Hartzell V ; Puga, Francisco J. ; Ilstrup, Duane M. / Late results of systemic atrioventricular valve replacement in corrected transposition. In: The Journal of Thoracic and Cardiovascular Surgery. 1995 ; Vol. 109, No. 4. pp. 642-653.
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abstract = "From December 1964 to October 1993, 40 patients (aged 5 months to 70 years, mean 21.8 years, median 13.6 years) with corrected transposition and systemic atrioventricular valve insufficiency underwent replacement ( n = 39) or repair ( n = 1) of the systemic atrioventricular valve. Thirty-nine patients had situs solitus and 1 had situs inversus. Associated anomalies included Ebstein's malformation of the systemic atrioventricular valve ( n = 22), ventricular septal defect ( n = 19), and pulmonary stenosis ( n = 14). Preoperatively, 16 patients (40.0{\%}) had complete heart block and 27 patients (67.5{\%}) were in New York Heart Association functional classes III and IV. The early mortality was 10.0{\%} ( n = 4) and 8 patients died subsequently. The principal cause of death in all 12 patients was systemic ventricular failure. Overall survival including early mortality was 78.0{\%} at 5 years and 60.7{\%} at 10 years; survival excluding early mortality was 86.7{\%} at 5 years and 67.5{\%} at 10 years. Survivorship correlated with preoperative systemic ventricular ejection fraction of 44{\%} or more ( p < 0.001) and later interval of operation (9 deaths in 15 patients before 1981 versus 3 deaths in 25 patients subsequently) ( p = 0.06). There were no cases of surgically induced complete heart block. Two patients underwent late reoperations related to the systemic atrioventricular valve prosthesis. Follow-up extended to 26.0 years (median 4.7 years). At last follow-up, 18 of the 28 survivors were in New York Heart Association functional class I, 9 were in class II, and 1 was in class III. We conclude that the results of systemic atrioventricular valve replacement in corrected transposition have improved significantly during the past decade. To preserve systemic ventricular function, we suggest operation be considered at the earliest sign of progressive ventricular dysfunction as assessed by serial clinical evaluation and echocardiography. (J THORAC CARDIOVASC SURG 1995;109:642-53).",
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AU - van Son, Jacques A M

AU - Danielson, Gordon K.

AU - Huhta, James C.

AU - Warnes, Carole A.

AU - Edwards, William D.

AU - Schaff, Hartzell V

AU - Puga, Francisco J.

AU - Ilstrup, Duane M.

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N2 - From December 1964 to October 1993, 40 patients (aged 5 months to 70 years, mean 21.8 years, median 13.6 years) with corrected transposition and systemic atrioventricular valve insufficiency underwent replacement ( n = 39) or repair ( n = 1) of the systemic atrioventricular valve. Thirty-nine patients had situs solitus and 1 had situs inversus. Associated anomalies included Ebstein's malformation of the systemic atrioventricular valve ( n = 22), ventricular septal defect ( n = 19), and pulmonary stenosis ( n = 14). Preoperatively, 16 patients (40.0%) had complete heart block and 27 patients (67.5%) were in New York Heart Association functional classes III and IV. The early mortality was 10.0% ( n = 4) and 8 patients died subsequently. The principal cause of death in all 12 patients was systemic ventricular failure. Overall survival including early mortality was 78.0% at 5 years and 60.7% at 10 years; survival excluding early mortality was 86.7% at 5 years and 67.5% at 10 years. Survivorship correlated with preoperative systemic ventricular ejection fraction of 44% or more ( p < 0.001) and later interval of operation (9 deaths in 15 patients before 1981 versus 3 deaths in 25 patients subsequently) ( p = 0.06). There were no cases of surgically induced complete heart block. Two patients underwent late reoperations related to the systemic atrioventricular valve prosthesis. Follow-up extended to 26.0 years (median 4.7 years). At last follow-up, 18 of the 28 survivors were in New York Heart Association functional class I, 9 were in class II, and 1 was in class III. We conclude that the results of systemic atrioventricular valve replacement in corrected transposition have improved significantly during the past decade. To preserve systemic ventricular function, we suggest operation be considered at the earliest sign of progressive ventricular dysfunction as assessed by serial clinical evaluation and echocardiography. (J THORAC CARDIOVASC SURG 1995;109:642-53).

AB - From December 1964 to October 1993, 40 patients (aged 5 months to 70 years, mean 21.8 years, median 13.6 years) with corrected transposition and systemic atrioventricular valve insufficiency underwent replacement ( n = 39) or repair ( n = 1) of the systemic atrioventricular valve. Thirty-nine patients had situs solitus and 1 had situs inversus. Associated anomalies included Ebstein's malformation of the systemic atrioventricular valve ( n = 22), ventricular septal defect ( n = 19), and pulmonary stenosis ( n = 14). Preoperatively, 16 patients (40.0%) had complete heart block and 27 patients (67.5%) were in New York Heart Association functional classes III and IV. The early mortality was 10.0% ( n = 4) and 8 patients died subsequently. The principal cause of death in all 12 patients was systemic ventricular failure. Overall survival including early mortality was 78.0% at 5 years and 60.7% at 10 years; survival excluding early mortality was 86.7% at 5 years and 67.5% at 10 years. Survivorship correlated with preoperative systemic ventricular ejection fraction of 44% or more ( p < 0.001) and later interval of operation (9 deaths in 15 patients before 1981 versus 3 deaths in 25 patients subsequently) ( p = 0.06). There were no cases of surgically induced complete heart block. Two patients underwent late reoperations related to the systemic atrioventricular valve prosthesis. Follow-up extended to 26.0 years (median 4.7 years). At last follow-up, 18 of the 28 survivors were in New York Heart Association functional class I, 9 were in class II, and 1 was in class III. We conclude that the results of systemic atrioventricular valve replacement in corrected transposition have improved significantly during the past decade. To preserve systemic ventricular function, we suggest operation be considered at the earliest sign of progressive ventricular dysfunction as assessed by serial clinical evaluation and echocardiography. (J THORAC CARDIOVASC SURG 1995;109:642-53).

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