Atrioventricular septal defects: effect of bridging leaflet division on early valve function

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Disease
• Valvular Heart Disease

Background:

• Atrioventricular septal defects (AVSD) are congenital heart abnormalities requiring surgical repair.
• Bridging leaflet division during AVSD repair is a technique that may facilitate the procedure.
• The impact of this division on early valve function and mortality remains unclear.

Purpose of the Study:

• To evaluate the consequences of bridging leaflet division on early valve function and mortality after atrioventricular septal defect repair.
• To identify risk factors associated with moderate or greater atrioventricular valve regurgitation (AVVR) and death/reoperation within one year post-repair.

Main Methods:

• Retrospective review of 209 children undergoing AVSD repair between January 1995 and January 2002.
• Multivariable analysis was used to determine risk factors for AVVR and death/reoperation.

Main Results:

• Division of bridging leaflets was associated with increased rates of moderate or greater AVVR within the first year post-repair.
• Risk factors for AVVR included technical aspects (number of leaflets divided, cross-clamp time) and patient-specific factors (preoperative AVVR, valve anomalies, age).
• Freedom from death/reoperation for AVVR was high, but specific risk factors were identified, and operative mortality was linked to reoperation failures and leaflet dehiscence.

Conclusions:

• Division of bridging leaflets is a significant risk factor for developing moderate or greater atrioventricular valve regurgitation (AVVR) in the first year after AVSD repair.
• Preserving bridging leaflet integrity may enhance valve competence, reduce the need for reoperation, and potentially decrease operative mortality.
• Further research into optimizing surgical techniques to preserve leaflet integrity is warranted.