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Updated: Jul 13, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
[Long-term results of complete atrio-ventricular canal correction]
A Dragulescu1, O Ghez, A Fraisse
1Cardiologie pédiatrique, Département de cardiologie, Hôpital d'Enfants de La Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05.
Insights
Surgical outcomes for complete atrio-ventricular canal have improved, with reduced mortality and redo surgery rates. Patients with Down syndrome show better prognosis and fewer long-term reoperations after surgical correction.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Context:
- Complete atrio-ventricular canal (CAVC) is a complex congenital heart defect.
- Surgical correction is the standard treatment for CAVC.
- Long-term outcomes and risk factors for reoperation require ongoing assessment.
Purpose:
- To evaluate the long-term prognosis following surgical repair of CAVC.
- To identify risk factors associated with mortality and the need for redo surgery.
- To analyze trends in surgical outcomes over time.
Summary:
- This study analyzed 126 patients who underwent CAVC repair between 1984 and 2006.
- In-hospital mortality decreased significantly over the study period (23.7% to 4.4%).
- Survival rates were 83.6% at a mean follow-up of 9.5 years, with redo surgery rates for valve insufficiency at 12.4% by 15 years.
Impact:
- Surgical treatment for CAVC has become increasingly effective, with improved survival and reduced reoperation rates.
- The closure of the atrio-ventricular valve cleft is a key surgical component.
- Patients with Down syndrome demonstrate a favorable prognosis with lower rates of long-term redo surgery.
Objectives:
To assess the prognosis of surgically corrected complete atrio-ventricular canal and determine risk factors for death and redo surgery.
Patients:
and method: From January 1984 to March 2006, 126 patients were distributed in 3 groups according to their date of intervention: group I (1984-1991), group II (1992-1999) and group III (2000-2006). They were operated at mean age of 8.35 + 13.3 months. Down syndrome was present in 99 patients (79%). A partial or total closure of the left atrio-ventricular valvular cleft was performed in 47 patients (37%).
Results:
The in-hospital mortality was at 14.28% (18 patients), including 23.7% in group I, 16.2% in group II and 4.4% in group III (p=0.06). The predictive factors of survival were the Down syndrome (p<0.05) and surgery of the left atrio-ventricular valvular cleft (p=0.05). An early reoperation was required in 6 cases, for a severe leak of this valve (n=4) or an important residual shunt (n=2). After a mean follow-up of 9.5+6.9 years, the survival rate was at 83.6% and 10 patients (9.9%) had a redo surgery for a leak of the left atrio-ventricular valve (n=6) or sub-aortic stenosis (n=4). The rate of no-redo surgery for valve insufficiency was at 94.2% at 5 years, 91.1% at 10 years and 87.6% at 15 years.
Conclusion:
The surgical treatment of complete atrio-ventricular canal became more and more efficient with poor rates of mortality and redo surgery during these last years. The closure of the left atrio-ventricular valve cleft, mostly partial, is frequently performed. Patients with the Down syndrome have a better vital prognosis and lower rates of long-term redo surgery.
