Long-Term Outcomes of External Repair as a Rescue Operation for Atrioventricular Groove Disruption

Background Atrioventricular groove disruption (AVGD) is an uncommon but lethal complication of mitral valve operations associated with mortality approaching 90%. Traditionally, an “internal” repair is performed requiring prosthesis explantation, complete atrioventricular groove reconstruction using...

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Published inThe Annals of thoracic surgery Vol. 103; no. 2; pp. 491 - 496
Main Authors Dobrilovic, Nikola, MD, Raman, Jaishankar, MD, PhD, Fingleton, James G., MD, Maslow, Andrew, MD, Singh, Arun K., MD
Format Journal Article
LanguageEnglish
Published Netherlands Elsevier Inc 01.02.2017
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Abstract Background Atrioventricular groove disruption (AVGD) is an uncommon but lethal complication of mitral valve operations associated with mortality approaching 90%. Traditionally, an “internal” repair is performed requiring prosthesis explantation, complete atrioventricular groove reconstruction using a patch positioned from within the cardiac cavity, and subsequent prosthesis reimplantation. This is a massive undertaking that is usually unsuccessful. We examine the utility of an alternative, “external” approach for rescue of AVGD. Methods A retrospective review was conducted of consecutive patients with AVGD after mitral operations at 3 North American medical centers. All patients underwent external repair as a rescue procedure. The external repair technique was conducted on cardiopulmonary bypass using direct suturing or felt-reinforced suturing, or both, of the atrioventricular groove. This was supplemented as needed with applications of BioGlue (CryoLife, Kennesaw, GA), external bovine pericardial patch, left atrial buttress, and coronary bypass grafting of the circumflex circulation. Results Between 1995 and 2015, 3,071 mitral valve operations resulted in 13 AVGDs (incidence, 0.42%). Average patient age was 75.2 years (range, 59–90 years), and 77% (10 of 13) were women. The 30-day mortality was 15.4% (2 of 13), and hospital mortality was 23.1% (3 of 13). Survival rates at 1, 3, and 5 years were 72.7%, 72.7%, and 44.4%, respectively. Seven patients are currently still alive and remain in no greater than New York Heart Association Functional Classification II. A stable pseudoaneurysm subsequently developed in 2 patients. Conclusions The incidence of AVGD after mitral operations is low. Despite an older population with more tissue fragility, the external approach represents an effective, alternative repair technique for rescue of AVGD with encouraging results.
AbstractList Atrioventricular groove disruption (AVGD) is an uncommon but lethal complication of mitral valve operations associated with mortality approaching 90%. Traditionally, an "internal" repair is performed requiring prosthesis explantation, complete atrioventricular groove reconstruction using a patch positioned from within the cardiac cavity, and subsequent prosthesis reimplantation. This is a massive undertaking that is usually unsuccessful. We examine the utility of an alternative, "external" approach for rescue of AVGD. A retrospective review was conducted of consecutive patients with AVGD after mitral operations at 3 North American medical centers. All patients underwent external repair as a rescue procedure. The external repair technique was conducted on cardiopulmonary bypass using direct suturing or felt-reinforced suturing, or both, of the atrioventricular groove. This was supplemented as needed with applications of BioGlue (CryoLife, Kennesaw, GA), external bovine pericardial patch, left atrial buttress, and coronary bypass grafting of the circumflex circulation. Between 1995 and 2015, 3,071 mitral valve operations resulted in 13 AVGDs (incidence, 0.42%). Average patient age was 75.2 years (range, 59-90 years), and 77% (10 of 13) were women. The 30-day mortality was 15.4% (2 of 13), and hospital mortality was 23.1% (3 of 13). Survival rates at 1, 3, and 5 years were 72.7%, 72.7%, and 44.4%, respectively. Seven patients are currently still alive and remain in no greater than New York Heart Association Functional Classification II. A stable pseudoaneurysm subsequently developed in 2 patients. The incidence of AVGD after mitral operations is low. Despite an older population with more tissue fragility, the external approach represents an effective, alternative repair technique for rescue of AVGD with encouraging results.
BACKGROUNDAtrioventricular groove disruption (AVGD) is an uncommon but lethal complication of mitral valve operations associated with mortality approaching 90%. Traditionally, an "internal" repair is performed requiring prosthesis explantation, complete atrioventricular groove reconstruction using a patch positioned from within the cardiac cavity, and subsequent prosthesis reimplantation. This is a massive undertaking that is usually unsuccessful. We examine the utility of an alternative, "external" approach for rescue of AVGD.METHODSA retrospective review was conducted of consecutive patients with AVGD after mitral operations at 3 North American medical centers. All patients underwent external repair as a rescue procedure. The external repair technique was conducted on cardiopulmonary bypass using direct suturing or felt-reinforced suturing, or both, of the atrioventricular groove. This was supplemented as needed with applications of BioGlue (CryoLife, Kennesaw, GA), external bovine pericardial patch, left atrial buttress, and coronary bypass grafting of the circumflex circulation.RESULTSBetween 1995 and 2015, 3,071 mitral valve operations resulted in 13 AVGDs (incidence, 0.42%). Average patient age was 75.2 years (range, 59-90 years), and 77% (10 of 13) were women. The 30-day mortality was 15.4% (2 of 13), and hospital mortality was 23.1% (3 of 13). Survival rates at 1, 3, and 5 years were 72.7%, 72.7%, and 44.4%, respectively. Seven patients are currently still alive and remain in no greater than New York Heart Association Functional Classification II. A stable pseudoaneurysm subsequently developed in 2 patients.CONCLUSIONSThe incidence of AVGD after mitral operations is low. Despite an older population with more tissue fragility, the external approach represents an effective, alternative repair technique for rescue of AVGD with encouraging results.
Background Atrioventricular groove disruption (AVGD) is an uncommon but lethal complication of mitral valve operations associated with mortality approaching 90%. Traditionally, an “internal” repair is performed requiring prosthesis explantation, complete atrioventricular groove reconstruction using a patch positioned from within the cardiac cavity, and subsequent prosthesis reimplantation. This is a massive undertaking that is usually unsuccessful. We examine the utility of an alternative, “external” approach for rescue of AVGD. Methods A retrospective review was conducted of consecutive patients with AVGD after mitral operations at 3 North American medical centers. All patients underwent external repair as a rescue procedure. The external repair technique was conducted on cardiopulmonary bypass using direct suturing or felt-reinforced suturing, or both, of the atrioventricular groove. This was supplemented as needed with applications of BioGlue (CryoLife, Kennesaw, GA), external bovine pericardial patch, left atrial buttress, and coronary bypass grafting of the circumflex circulation. Results Between 1995 and 2015, 3,071 mitral valve operations resulted in 13 AVGDs (incidence, 0.42%). Average patient age was 75.2 years (range, 59–90 years), and 77% (10 of 13) were women. The 30-day mortality was 15.4% (2 of 13), and hospital mortality was 23.1% (3 of 13). Survival rates at 1, 3, and 5 years were 72.7%, 72.7%, and 44.4%, respectively. Seven patients are currently still alive and remain in no greater than New York Heart Association Functional Classification II. A stable pseudoaneurysm subsequently developed in 2 patients. Conclusions The incidence of AVGD after mitral operations is low. Despite an older population with more tissue fragility, the external approach represents an effective, alternative repair technique for rescue of AVGD with encouraging results.
Author Raman, Jaishankar, MD, PhD
Fingleton, James G., MD
Singh, Arun K., MD
Maslow, Andrew, MD
Dobrilovic, Nikola, MD
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SSID ssj0002155
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Snippet Background Atrioventricular groove disruption (AVGD) is an uncommon but lethal complication of mitral valve operations associated with mortality approaching...
Atrioventricular groove disruption (AVGD) is an uncommon but lethal complication of mitral valve operations associated with mortality approaching 90%....
BACKGROUNDAtrioventricular groove disruption (AVGD) is an uncommon but lethal complication of mitral valve operations associated with mortality approaching...
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StartPage 491
SubjectTerms Academic Medical Centers
Aged
Aged, 80 and over
Cardiopulmonary Bypass - methods
Cardiopulmonary Bypass - mortality
Cardiothoracic Surgery
Cause of Death
Databases, Factual
Extracorporeal Membrane Oxygenation - methods
Extracorporeal Membrane Oxygenation - mortality
Female
Follow-Up Studies
Heart Atria - injuries
Heart Atria - surgery
Heart Valve Prosthesis Implantation - adverse effects
Heart Valve Prosthesis Implantation - methods
Heart Ventricles - injuries
Heart Ventricles - surgery
Hospital Mortality
Humans
Male
Middle Aged
Minimally Invasive Surgical Procedures - methods
Mitral Valve Insufficiency - surgery
Mitral Valve Stenosis - surgery
Postoperative Complications - physiopathology
Postoperative Complications - surgery
Reoperation - methods
Reoperation - mortality
Retrospective Studies
Risk Assessment
Surgery
Survival Analysis
Treatment Outcome
Title Long-Term Outcomes of External Repair as a Rescue Operation for Atrioventricular Groove Disruption
URI https://www.clinicalkey.es/playcontent/1-s2.0-S0003497516310906
https://dx.doi.org/10.1016/j.athoracsur.2016.08.024
https://www.ncbi.nlm.nih.gov/pubmed/27788941
https://search.proquest.com/docview/1835688855
Volume 103
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