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Published on: December 11, 2017
Primary biventricular repair of atrioventricular septal defects: an analysis of reoperations
Hunaid A Vohra1, Alicia X F Chia, Ho Ming Yuen
1Wessex Cardiothoracic Centre, Southampton University Hospitals, Southampton, United Kingdom.
Insights
Down syndrome and right ventricular dominance increase reoperation risk after atrioventricular septal defect (AVSD) repair. Biventricular repair is successful for isolated AVSD, with good long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Atrioventricular septal defect (AVSD) is a complex congenital heart anomaly.
- Biventricular repair aims to correct AVSD while preserving or restoring normal ventricular function.
- Reoperation after initial repair can impact long-term outcomes.
Purpose of the Study:
- To identify factors influencing reoperation rates following primary biventricular repair of AVSD.
- To evaluate the long-term efficacy and safety of biventricular AVSD repair.
Main Methods:
- Retrospective analysis of 93 patients undergoing biventricular AVSD repair between 1997 and 2007.
- Detailed review of patient demographics, defect types, surgical procedures, and reoperation indications.
- Multivariate analysis to determine independent predictors of reoperation.
Main Results:
- No in-hospital mortality; 2.2% late mortality.
- 24.7% of patients required reoperation, primarily for atrioventricular valve regurgitation.
- Down syndrome and right ventricular dominance were significant predictors of reoperation (p=0.01 and p=0.03, respectively).
- High rates of functional improvement and absence of significant valve regurgitation at long-term follow-up.
Conclusions:
- Down syndrome and right ventricular dominance are key risk factors for reoperation after complete AVSD repair.
- Biventricular repair is a safe and effective strategy for isolated AVSD, even with a small left ventricle.
- Successful biventricular repair leads to favorable long-term functional status and reduced need for reoperation.
Background:
The purpose of this study was to analyze the factors affecting reoperation after primary biventricular atrioventricular septal defect (AVSD) repair.
Methods:
Between April 1997 and April 2007, 93 consecutive patients underwent surgery for biventricular correction of AVSD with a median age of 5.8 months (range, 9 days to 68.9 years). Fifty-three patients had complete AVSD, 6 patients had an intermediate type, and 29 patients had partial AVSD; 4 patients had a complete AVSD with associated tetralogy of Fallot, and 1 patient had a complete AVSD with double-outlet right ventricle.
Results:
There was no in-hospital mortality. There were 2 late deaths (2.2%). Forty-three reoperations were performed in 23 patients (24.7%), of which 18 were for repair of significant left atrioventricular valve regurgitation and 8 were mitral valve replacements. Seven patients (7.5%) required insertion of a permanent pacemaker. The overall 5-year freedom from reoperation after AVSD repair was 73.6% +/- 4.8%. In the multivariate analysis for complete AVSDs, Down syndrome (p = 0.01) and the presence of right ventricular dominance (p = 0.03) were independent predictors of reoperation. At last follow-up, 76 patients (83.5%) were in New York Heart Association class I, and 68 patients (74.7%) were not taking any heart failure medications. Echocardiographic examination showed absent to mild left atrioventricular valve regurgitation in 76.5%; moderate, in 19.8%; and severe, in 3.7% of patients.
Conclusions:
Down syndrome and right ventricular dominance are independent predictors of reoperation after complete AVSD repair. Biventricular repair of isolated AVSD with a small left ventricle can be successfully accomplished with no mortality.
