Repair of Common Atrioventricular Valve in Univentricular Circulation Using Adjustable Annular Bridging Technique

Abstract

The main reason for common atrioventricular valve regurgitation is the enlargement of the valve annulus contralaterally to the aorta and pulmonary artery. Edge-to-edge repair can be used to address the regurgitation; however, there might be potential disadvantage that a fixed bridging leaflet could have a restrictive motion, leading to recurrence of atrioventricular valve regurgitation. To avoid this issue and address the anteroposterior dilatation of the annulus, we have developed an adjustable annular bridging technique. The main reason for common atrioventricular valve regurgitation is the enlargement of the valve annulus contralaterally to the aorta and pulmonary artery. Edge-to-edge repair can be used to address the regurgitation; however, there might be potential disadvantage that a fixed bridging leaflet could have a restrictive motion, leading to recurrence of atrioventricular valve regurgitation. To avoid this issue and address the anteroposterior dilatation of the annulus, we have developed an adjustable annular bridging technique. Commentary: The Adjustable Bridge – Definitely a Useful Technique; HoweverOperative Techniques in Thoracic and Cardiovascular SurgeryVol. 27Issue 3PreviewI am grateful to the authors and commend them for sharing their technique of adjustable annular bridge for patients with single-ventricle (SV) hearts and atrioventricular valve regurgitation (AVVR).1 They have provided clear technical detail and excellent illustrations and video. No one questions the significance of AVVR in these patients, its significant impact on prognosis, and the difficulty in achieving durable, excellent valve competence. Likewise, we acknowledge the numerous technical repair tools at our disposal and that frequently we use most, if not all, of them in any given case (side to side, cleft or scallop closure, various degrees of annuloplasty, etc.). Full-Text PDF Commentary: Atrioventricular Valve Repair in Univentricular Hearts: No Longer a Bridge Too Far?Operative Techniques in Thoracic and Cardiovascular SurgeryVol. 27Issue 3PreviewIt is increasingly apparent that atrioventricular valve (AVV) failure is a major cause of mortality in patients with a Fontan circulation.1 Furthermore, patients with a common AVV are at the highest risk of AVV failure among those with a Fontan circulation.1-4 Atrioventricular valve repair is notoriously difficult in the setting of a common AVV, and failed repair is associated with very high mortality.3 One of the major contributing factors to AVV failure in these patients is the attenuated fibrous skeleton of the heart, which increases the risk of annular dilatation. Full-Text PDF