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Improved results after repair of complete atrioventricular septal defect
Masamichi Ono1, Heidi Goerler, Dietmar Boethig
1Division of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany. Ono.Masamichi@mh-hannover.de
Insights
Early surgical repair of complete atrioventricular septal defect (AVSD) significantly improves survival rates. While outcomes have improved, a high pulmonary vascular resistance index remains a risk factor for early mortality.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Medical Outcomes Research
Background:
- Complete atrioventricular septal defect (AVSD) is a complex congenital heart defect.
- Historical outcomes of early primary repair of complete AVSD were evaluated.
- Changes in treatment protocols over decades were analyzed.
Purpose of the Study:
- To assess the historical impact of early primary repair on complete AVSD outcomes.
- To compare results between conservative/selective repair and universal early repair strategies.
- To identify risk factors affecting mortality and reoperation rates.
Main Methods:
- Retrospective analysis of 185 children with complete AVSD treated since 1976.
- Comparison of two groups: pre-1990 (conservative/selective repair) and post-1990 (universal early repair).
- Analysis of pre- and postoperative parameters, including survival and reoperation-free survival.
Main Results:
- Actuarial survival at 15 years significantly improved in the early repair group (90.8% vs. 69.3%).
- No significant difference in freedom from left atrioventricular valve reoperation at 15 years.
- A high pulmonary vascular resistance index (RPI >6.0 WU/m(2)) was identified as an independent risk factor for early death.
Conclusions:
- Earlier surgical intervention for complete AVSD, including patients with Down syndrome, has demonstrably improved outcomes.
- Despite advances, elevated RPI remains a critical predictor of early mortality.
- Optimized surgical timing and patient selection are key to improving long-term results in pediatric cardiac surgery.
Background:
This study evaluates the historical impact on the outcomes of early primary repair of complete atrioventricular septal defect (AVSD) at our institute.
Methods:
Since 1976, a total of 185 children with complete AVSD have been referred to our unit. Prior to 1990, 78 children received conservative therapy, and selected 51 patients underwent surgical repair (group 1). After 1990, all referred children underwent surgical repair (n = 56; group 2). Pre- and postoperative parameters were analyzed and compared among the groups.
Results:
Age at operation was 15.4 +/- 20.4 versus 9.9 +/- 18.0 months in group 1 and group 2, respectively. Association with Down syndrome (53% vs. 82%; p < 0.01) and with patent ductus arteriosus (16 vs. 34%; p < 0.05) was less frequent in group 1. No difference was seen regarding preoperative pulmonary vascular resistance index (RPI). Actuarial survival at 15 years has improved in group 2 (69.3 +/- 6.7 vs. 90.8 +/- 3.9%; p < 0.05). Freedom from reoperation of the left atrioventricular valve at 15 years was not significantly different (78.8 +/- 6.8 vs. 90.6 +/- 4.7%; p = 0.23). Risk factor analysis identified an RPI >6.0 WU/m(2) as a risk for early death.
Conclusion:
By operating on the patients with complete AVSD earlier and not excluding patients with Down syndrome, recent results had definitely improved over the last decades. Despite this positive result, a high RPI exceeding 6 WU/m(2) still remains a risk factor for early mortality independent of early primary repair.
