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What is the best technique for repair of complete atrioventricular canal?
Carl Lewis Backer1, Robert D Stewart, Constantine Mavroudis
1Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60614, USA. cbacker@childrensmemorial.org
Insights
The modified single-patch technique offers superior outcomes for complete atrioventricular canal (CAVC) repair in children. This method shows a lower incidence of mitral valve reoperation and heart block compared to other surgical approaches.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiovascular Surgery
Background:
- Complete atrioventricular canal (CAVC) is a complex congenital heart defect requiring surgical intervention.
- Current surgical options for CAVC include classic single-patch, two-patch, and modified single-patch techniques.
- The modified single-patch technique has emerged as a preferred method for pediatric CAVC repair.
Purpose of the Study:
- To review the authors' experience with the modified single-patch technique for CAVC repair.
- To compare the outcomes of the modified single-patch technique with classic single-patch and two-patch techniques.
- To highlight the advantages of the modified single-patch technique in pediatric patients.
Main Methods:
- Retrospective analysis of outcomes from the authors' institution and other centers using the modified single-patch technique.
- Comparison of operative mortality, late mortality, mitral valve reoperation rates, and heart block incidence.
- Benchmarking against current results of classic single-patch and two-patch techniques.
Main Results:
- Operative and late mortality rates were comparable across all three surgical techniques.
- The modified single-patch technique demonstrated a significantly lower incidence of late reoperations for mitral valve insufficiency.
- Patients undergoing repair with the modified single-patch technique experienced a lower rate of heart block.
Conclusions:
- The modified single-patch technique is associated with reduced rates of mitral valve reoperation and heart block in pediatric CAVC repair.
- Its simplicity and favorable outcomes support its adoption as the procedure of choice.
- This technique offers significant advantages for managing complete atrioventricular canal in infants and children.
Abstract:
Surgical management of pediatric patients with the diagnosis of complete atrioventricular canal (CAVC) is accomplished by using one of three procedures: (1) the classic single-patch, (2) two-patch, or (3) modified single-patch technique. Of these, the modified single-patch is currently the best technique available for repair of CAVC. The goal of this review is to describe our experience with the modified single-patch technique and explain how it evolved into our procedure of choice for repair of CAVC in our pediatric population. We analyzed specific outcomes (operative mortality, late mortality, mitral valve reoperation, and the incidence of heart block) from our center and those of other institutions that used the modified single-patch technique and compared these with the most current results of the classic single-patch and two-patch techniques reported from several other centers. Our analysis showed that while the occurrence of operative and late mortality was comparable in all three techniques, there was clearly a lower incidence of late reoperations for mitral valve insufficiency and a lower rate of heart block in patients who were repaired with the modified single-patch technique. For these reasons and because of its simplicity, we have adopted the modified single-patch technique as our procedure of choice for repair of complete atrioventricular canal in infants and children.
