Systemic-to-pulmonary shunt and progression of atrioventricular valve regurgitation: A multicenter study identifying high-risk physiology

Objective: To evaluate the progression of systemic atrioventricular valve regurgitation (sAVVR) after the insertion of a systemic-to-pulmonary artery (SP) shunt. Methods: This multicenter, retrospective study (2009-2024) enrolled patients undergoing primary SP shunt and divided them into biventricular (BiV) and univentricular (UniV) groups. The primary outcome was the change in sAVVR grade between preoperative and second-stage repair. Secondary outcomes included changes in systemic atrioventricular valve annulus diameter (sAVVD), systemic ventricular diastolic diameter (sVDd), and bilateral pulmonary artery (PA) sizes. Subgroup analyses were performed for UniV by the presence of common atrioventricular valve and ventricle morphology. Results: < .05), with greater sAVVD and sVDd enlargement in patients with heterotaxy. Conclusions: SP was associated with sAVVR progression in both BiV and UniV; however, clinically significant sAVVR was uncommon in BiV. Heterotaxy independently predicted sAVVR progression, likely due to greater AV valve and ventricular dilatation.