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Early repair of complete atrioventricular septal defect is safe and effective
R Ramesh Singh1, Patrick S Warren, T Brett Reece
1Department of Surgery, University of Virginia, Charlottesville, Virginia 22908, USA.
Insights
Surgical repair of complete atrioventricular septal defect (CAVSD) in infants younger than 3 months shows similar outcomes to those repaired after 3 months. Modern techniques ensure comparable safety and efficacy for early CAVSD repair.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects
- Atrioventricular Septal Defects
Background:
- Complete atrioventricular septal defect (CAVSD) repair is a standard pediatric surgical procedure.
- The study investigates the safety and efficacy of CAVSD repair in infants under 3 months compared to older children.
Purpose of the Study:
- To test the hypothesis that modern surgical techniques yield equal risks for CAVSD repair in children younger than 3 months and older than 3 months.
Main Methods:
- Retrospective review of 65 infants and children undergoing CAVSD repair between 1990 and 2004.
- Patients were divided into two groups: repair at or before 3 months (Group A) and after 3 months (Group B).
- Individualized surgical approaches were used for ventricular septal defect repair, with standardized closure for atrioventricular commissures and atrial defects.
Main Results:
- Hospital mortality rates were comparable between Group A (7.7%) and Group B (2.6%), with no statistically significant difference (p = 0.33).
- Early reoperation rates for residual defects or mitral regurgitation were also similar: 11.5% in Group A versus 10.3% in Group B (p = 0.68).
Conclusions:
- Surgical repair of CAVSD in infants under 3 months of age demonstrates outcomes comparable to those repaired after 3 months.
- Modern surgical techniques support similar safety and efficacy for early intervention in CAVSD.
Background:
Surgical repair of complete atrioventricular septal defect (CAVSD) is a well-established procedure performed on young children. Our hypothesis is that with modern techniques, the current risks of CAVSD repair in children aged younger than 3 months and in children older than 3 months are equal.
Methods:
This was a retrospective review of 65 infants and children with a mean age of 10.9 months (range, 1 month to 15.5 years) who underwent CAVSD repair from 1990 to 2004. Twenty-six repairs (40%) were done on or before 3 months of age (group A) and 39 repairs (60%) were done after 3 months of age (group B). In all patients, the ventricular septal defect was repaired with an individualized approach according to each patient's specific anatomy: direct suturing without a patch, interposition of a small pericardial patch with a running suture, or both. The atrioventricular commissure was closed with interrupted sutures, and all atrial defects were closed with a pericardial patch. Data were analyzed using the chi2 analysis and the Fisher exact test.
Results:
Three hospital deaths occurred (<30 days), 2 in group A and 1 in group B (7.7% vs 2.6%, respectively, p = 0.33). One death in group A occurred during another noncardiac surgery. Early reoperation (<1 year of initial surgery) for residual ventricular septal defect or significant mitral regurgitation, or both, occurred in 3 group A patients and in 4 group B patients (11.5% versus 10.3% respectively, p = 0.68).
Conclusions:
These results suggest that repair of CAVSD defects in children 3 months of age or younger had similar outcomes compared with those who underwent surgical repair after 3 months of age.
