Atrioventricular valve repair along with Fontan completion.

Atrioventricular valve regurgitation is widely known as a risk factor for Fontan completion in patients with univentricular physiology. To date, indications and timing for atrioventricular valve repair remain unclear and different surgical techniques have been advocated. Since 2013, 50 consecutive patients underwent extracardiac Fontan completion in our institution. Atrioventricular valve repair, by avoiding the use of a prosthetic ring, was performed as a concomitant procedure in three of them, with excellent short-term results. Beating-heart repair was performed in one of the patients with hypoplastic left heart syndrome as the underlying disease. Valve repair when moderate or severe regurgitation is present may be performed at a low risk. Both the staged approach of atrioventricular valve repair followed by the Fontan as a separate operation and the combined approach of simultaneous atrioventricular valve repair and Fontan have a role in the management of these complex patients. We highlight the importance of the use of "easy and simple" surgical techniques for repairing the atrioventricular valve in order to provide a better life prognosis in Fontan patients.