Key result
Hammock mitral valve is linked to ~11-fold higher mortality after biventricular repair for Shone's complex.
Why the study?
The midterm outcomes and risk factors for mortality and reoperation after biventricular repair surgery in patients with Shone's complex were not well characterized.
Cohort (n=34)
In patients undergoing biventricular repair for Shone's complex, midterm mortality and reoperation rates are substantial, with specific anatomical variants like hammock mitral valve strongly predicting mortality.
Hammock mitral valve signals high-risk Shone's patients after biventricular repair; hypothesis-generating and requires prospective validation before guiding practice.
OBJECTIVE: The midterm results of patients who underwent biventricular repair surgery for Shone's complex were examined, and mortality and reoperation risk factors were evaluated. METHODS: This retrospective study included 34 patients with Shone's complex who underwent mitral valve (MV) surgery between 2005 and 2020. RESULTS: A total of 19 patients (56%) had coarctation, 10 (29%) patients had subaortic stenosis, 9 (26.5%) patients had a hypoplastic aortic arch (AA), and 9 (26.5%) patients had aortic valve (AV) stenosis. Twenty-four (70.6%) patients had bileaflet AV. Associated left-sided in-flow stenotic lesions included parachute MV in 19 (56%) patients and supramitral ring in 18 (53%) patients. The estimated freedom from reoperation rate on the 6th month, 1 year and 2 years after surgery was 84.4%, 79.5%, and 71.5%, respectively. The overall mortality rate was 20.6% (seven patients) with a median follow-up of 10 months (0-41). The estimated survival rate on the 6th month, 1 year, and 3 years after surgery was 83.8%, 79.4%, and 79.4 respectively. Bicuspid aortic valve (p = .017) (HR (95% CI) = 0.130 (0.025-0.695) and hammock mitral valve (p = .038) (HR (95% CI) = 11,008 (1,146->100) were associated with mortality. CONCLUSION: The presence of a bicuspid aortic valve hammock mitral valve might have an effect on negative effect on the outcome.
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Altın et al. (2022) conducted a cohort in Shone's complex (n=34). Biventricular repair surgery was evaluated on overall mortality. Following biventricular repair surgery for Shone's complex, the overall mortality rate was 20.6% at a median 10 months, with hammock mitral valve identified as a significant risk factor (HR 11.008; P=0.038).
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