Surgical repair of complete atrioventricular septal defect
1Department of Surgery, Medical University of South Carolina, Charleston 29425, USA. crawfrdf@musc.edu
Insights
Complete atrioventricular septal defect repair outcomes show decreased operative mortality over two decades. However, late reoperation for mitral regurgitation remains a significant concern, necessitating improved surgical techniques.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Atrioventricular septal defects (AVSD) are complex congenital heart conditions.
- Surgical repair outcomes for AVSD have evolved over time.
Purpose of the Study:
- To assess the long-term outcomes of complete atrioventricular septal defect repair.
- To evaluate changes in operative mortality and reoperation rates over two decades (1981-2000).
Main Methods:
- A single-surgeon series of 172 consecutive patients undergoing AVSD repair.
- Consistent surgical technique involving single-patch closure and cleft repair.
- Analysis of operative mortality, long-term survival, and reoperation for mitral regurgitation.
Main Results:
- Overall operative mortality was 8.7%, significantly decreasing from 16.4% in the first decade to 3.0% in the second.
- Long-term survival was 79.0% at 15 years.
- Late reoperation for mitral regurgitation occurred in 6.4% of survivors, with no significant improvement between decades.
Conclusions:
- Operative mortality for AVSD repair has dramatically decreased.
- The incidence of late reoperation for mitral regurgitation has not improved.
- Novel techniques are required to better address late mitral regurgitation after AVSD repair.
Background:
The objective of this study was to assess the outcome of complete atrioventricular septal defect repair from 1981 to 2000.
Methods:
One hundred seventy-two consecutive patients with atrioventricular septal defect were operated on by a single surgeon using a consistent operative technique (single patch; "cleft" closure). The patients' age range was from 5 weeks to 9 years (mean, 10.8 +/- 1.2 months).
Results:
Overall operative mortality was 15 of 172 (8.7%) and this decreased significantly from 12 of 73 (16.4%) in the first decade to 3 of 99 (3.0%) in the second decade (p = 0.0021) with no operative deaths in the last 51 patients. Operative mortality was related to decade of operation (p = 0.0021) and to use of crystalloid cardioplegia (p = 0.0047) by univariate analysis, and to decade of operation (p = 0.0016) and postoperative time on ventilator (p = 0.0023) by multivariate analysis. Actuarial long-term survival including operative deaths was 79.0% +/- 3.8% at 15 years. Ten of 157 (6.4%) operative survivors have undergone reoperation for late mitral regurgitation (9 mitral valve repair, 1 mitral valve replacement) with one death. Four of 8 patients surviving late mitral valve replacement have subsequently required mitral valve repair. Freedom from late reoperation for severe mitral regurgitation was 89.9% +/- 3.1% at 15 years. Freedom from late reoperation for mitral regurgitation did not decrease in the second decade (84.2% +/- 6.6% at 10 years) versus the first decade (94.5% +/- 3.1%) (p = 0.0679).
Conclusions:
Although operative mortality for repair of atrioventricular septal defect has decreased dramatically during the past decade, the incidence of late reoperation for mitral regurgitation has not improved, and better techniques to eliminate late mitral regurgitation are needed.
