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What is the optimal time to repair atrioventricular septal defect and common atrioventricular valvar orifice?
Brian E Kogon1, Hunter Butler, Michael McConnell
1Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia 30322, USA. Brian_kogon@emoryhealthcare.org
Insights
Early surgical repair of atrioventricular septal defects is safe in smaller children. While complications are slightly higher, outcomes remain excellent, avoiding heart failure and promoting growth.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Repair
- Atrioventricular Septal Defect Management
Background:
- Technological advancements enable surgical repair of atrioventricular septal defects (AVSD) in smaller pediatric patients.
- Early intervention aims to prevent heart failure, support growth, and reduce pulmonary hypertension.
- Comparative outcome analysis across different pediatric weight groups is crucial for refining surgical strategies.
Purpose of the Study:
- To compare the surgical outcomes of balanced atrioventricular septal defect repair in children of varying sizes.
- To evaluate the safety and efficacy of early surgical intervention for symptomatic infants and young children.
- To identify potential risks and benefits associated with repairing smaller infants.
Main Methods:
- Retrospective review of 92 patients undergoing AVSD repair with a common atrioventricular valvar orifice and balanced ventricles (December 2002 - July 2005).
- Inclusion criteria: patients weighing ≤10 kg; exclusion criteria: other major concomitant procedures.
- Analysis of operative times, cardiopulmonary bypass duration, and postoperative outcomes including ventilation, ICU/hospital stay, residual defects, valvar regurgitation, and complications.
Main Results:
- Median weight at repair was 4.9 kg (range 2.93-7.9 kg); median age was 5.1 months (range 0.39-9.6 months).
- Operative times were not significantly affected by patient weight.
- Decreasing weight correlated with significantly longer intensive care unit (p=0.006) and hospital stays (p=0.007), and a higher incidence of complications (p=0.0043), but not residual defects or valvar regurgitation.
Conclusions:
- Early surgical repair of symptomatic atrioventricular septal defects with common atrioventricular valvar orifice is safe and effective in smaller children.
- While postoperative recovery may be slightly longer and more complicated in smaller infants, excellent long-term outcomes can be achieved.
- This approach minimizes the need for aggressive medical therapy, supports normal growth, and prevents elevated pulmonary pressures.
Objective:
With improvements in technology and surgical technique, paediatric cardiologists are challenging surgeons to repair balanced atrioventricular septal defects in smaller patients. Early repair minimizes aggressive medical therapy to prevent heart failure, maintains growth, and limits exposure to elevated pulmonary pressures. We compare the outcomes of repair among different-sized children.
Methods:
From December 2002 to July 2005, 92 patients underwent repair of an atrioventricular septal defect with common atrioventricular valvar orifice and balanced ventricles. We reviewed operative and postoperative data. We excluded patients weighing more than 10 kilograms, but included those who underwent concomitant closure of a patent oval foramen or atrial septal defect, or ligation of a patent arterial duct. Those requiring other concomitant procedures were excluded from the analysis.
Results:
The median weight at repair was 4.9 kilograms, with a range from 2.93 to 7.9 kilograms, and the median age was 5.1 months, with a range from 0.39 to 9.6 months. Operative data included the time required for cardiopulmonary bypass, aortic cross-clamping, and the overall procedure. These times were not significantly affected by decreasing weight. Postoperative continuous data included duration of ventilation and length of intensive care unit and hospital stay. Stay in intensive care (p = 0.006) and hospital (p = 0.007) both increased significantly with decreasing weight. Postoperative categorical data included presence of residual ventricular septal defects, regurgitation across the left atrioventricular valve, and complications. While there was no difference in residual defects (p = 0.166) or valvar regurgitation (p = 0.729), there was a significantly higher presence of complications with decreasing weight (p = 0.0043). There was no mortality, and no persistent heart block requiring placement of a permanent pacemaker.
Conclusions:
Our data shows that, with the exception of a slightly longer and more complicated postoperative course, early surgery for symptomatic patients with atrioventricular septal defects and common atrioventricular valvar orifice can be undertaken safely and effectively in smaller children with excellent outcomes.
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