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Primary repair for complete atrioventricular canal: recommendation for early primary repair
1Department of Cardiovascular Surgery and Cardiology, Fukuoka Children's Hospital, Japan.
Insights
Early surgical repair of complete atrioventricular canal (CAVC) in infants is linked to better outcomes. Younger patients showed fewer atrioventricular valve issues and lower pulmonary vascular resistance post-surgery.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiac Surgery Outcomes
Background:
- Complete atrioventricular canal (CAVC) is a complex congenital heart defect requiring surgical intervention.
- The optimal timing for primary repair of CAVC remains a subject of ongoing clinical investigation.
- Previous studies suggest potential benefits of early surgical correction for congenital heart anomalies.
Purpose of the Study:
- To evaluate the impact of age at primary repair on surgical outcomes in patients with CAVC.
- To assess the relationship between repair timing and long-term valve function, cardiac dimensions, and pulmonary vascular resistance.
- To determine if earlier surgical intervention for CAVC is associated with improved clinical results.
Main Methods:
- Retrospective analysis of 40 patients undergoing primary CAVC repair between 1981 and 1989.
- Patients were grouped based on age at repair: <6 months (Group 1), 7-11 months (Group 2), and >12 months (Group 3).
- Outcomes assessed included surgical mortality, atrioventricular valve degeneration, mitral regurgitation, left atrium/aorta ratio, mitral valve annulus growth, and pulmonary vascular resistance.
Main Results:
- Surgical mortality was 2.5%.
- Increased age at repair correlated significantly with greater atrioventricular valve degeneration (p<0.05, Group 1 vs. Group 3).
- Lower pulmonary vascular resistance was observed in the early repair group (Group 1) compared to later repair groups (p<0.01 vs. Group 3).
Conclusions:
- Early primary repair of CAVC (before 6 months) appears beneficial, associated with less atrioventricular valve degeneration.
- Infants undergoing early repair demonstrated favorable pulmonary vascular resistance post-operatively.
- The findings support the justification for considering early surgical intervention in the management of complete atrioventricular canal.
Abstract:
Forty patients with complete atrioventricular canal (CAVC) underwent primary repair at Fukuoka Children's Hospital in Fukuoka, Japan, between August 1, 1981 and July 31, 1989. The age at repair ranged from 2 months to 6 years (mean 19 months); weight ranged from 2.3 to 22 kg. The surgical mortality was 2.5%. Justification for early primary repair was examined. Eleven patients underwent repair before 6 months of age (Group 1), 12 patients, between 7 and 11 months of age (Group 2), and 17 patients, after 12 months of age (Group 3). Degenerative changes in the atrioventricular valve increased significantly as age at repair increased (p less than 0.05 Group 1 versus Group 3). The incidence of residual mitral regurgitation tended to increase in the order of Group 1, 2 and 3, though the degree ranged from trivial to mild. Study of the left atrium/aorta ratio by echocardiography revealed that stable values of around 1.1 in Groups 1 and 2 and around 1.3 in Group 3 continued during the follow-up period of 3 years. Assessment of the diameter of the repaired mitral valve in the mean interval of 26 months in groups 1 and 2 revealed normal growth of the mitral valve annulus. The angle between the repaired mitral valve and ventricular septum, which can be affected by the growth of the ventricular septum, converged to normal range in the mean interval of 26 months. Postoperative pulmonary vascular resistance in Groups 2 and 3 was higher at 4.4 +/- 2.3 and 6.3 +/- 2.2, respectively, than in Group 1 at 3.3 +/- 2.2 (p less than 0.01 versus Group 3).(ABSTRACT TRUNCATED AT 250 WORDS)