Play safe: band the late presenting complete atrioventricular canal

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease Surgery
• Cardiovascular Physiology

Background:

• Complete atrioventricular canal (CAVC) diagnosed after one year of age presents significant surgical challenges.
• Late presentation of CAVC is often associated with severe reactive pulmonary hypertension, increasing operative risk.
• Primary repair in this cohort historically carries a high mortality rate.

Purpose of the Study:

• To evaluate the efficacy and safety of a two-stage surgical approach for complete atrioventricular canal in older infants.
• To assess the impact of pulmonary artery banding followed by total correction on mortality and functional status.
• To determine if this strategy mitigates risks in patients with severe pulmonary hypertension.

Main Methods:

• A retrospective review of 16 patients with complete atrioventricular canal, aged 8-24 months, who underwent pulmonary artery banding followed by total correction.
• Patients were surgically managed between January 1995 and February 2000.
• Outcomes including hospital mortality, late mortality, and functional class (New York Heart Association) were analyzed.

Main Results:

• One hospital death occurred, resulting in a mortality rate of 6.25%.
• No late deaths were observed during a mean follow-up of 10.2 months.
• Of the 15 survivors, 87% achieved New York Heart Association functional class I, while 13% remained in class III.

Conclusions:

• Pulmonary artery banding followed by complete repair is a viable strategy for complete atrioventricular canal presenting beyond one year of age.
• This staged approach effectively reduces the high mortality associated with primary repair in late-presenting patients with severe pulmonary hypertension.
• The combined strategy improves long-term functional outcomes in this challenging pediatric cardiac population.