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

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.