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Early postoperative outcomes following surgical repair of complete atrioventricular septal defects: is down syndrome
Ajay R Desai1, Ricardo G Branco, George A Comitis
1All authors: Department of Pediatrics, Royal Brompton Hospital NHS Foundation Trust, London, United Kingdom.
Insights
Children with Down syndrome undergoing complete atrioventricular septal defect repair had similar early outcomes but more noncardiac complications. Further studies are needed to confirm findings on atrioventricular valve dysplasia.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Genetics
Background:
- Complete atrioventricular septal defect (CAVSD) is a common congenital heart defect, often associated with Down syndrome.
- Early surgical repair is standard, but the impact of Down syndrome on postoperative outcomes requires further elucidation.
Purpose of the Study:
- To evaluate the early postoperative outcomes of children with Down syndrome undergoing complete atrioventricular septal defect repair.
- To compare outcomes between children with and without Down syndrome.
Main Methods:
- Retrospective cohort study at a single tertiary pediatric cardiac center.
- Included 107 children undergoing biventricular surgical repair of CAVSD from 2004-2009.
- Compared outcomes between 67 children with Down syndrome and 40 without.
Main Results:
- No significant difference in early postoperative mortality or need for reoperation.
- Similar prevalence of atrioventricular valve dysplasia and junctional ectopic tachycardia.
- Children with Down syndrome experienced significantly more noncardiac complications (pneumothorax, pleural effusions, infections).
- No difference in the duration of PICU stay, but a trend towards longer mechanical ventilation in the Down syndrome group.
Conclusions:
- Early postoperative outcomes and atrioventricular valve dysplasia prevalence were similar between groups.
- Children with Down syndrome had a higher incidence of noncardiac complications post-CAVSD repair.
- Further research is needed to confirm findings on atrioventricular valve dysplasia, contrasting with prior literature.
Objective:
To evaluate the impact of Down syndrome on the early postoperative outcomes of children undergoing complete atrioventricular septal defect repair.
Design:
Retrospective cohort study.
Setting:
Single tertiary pediatric cardiac center.
Patients:
All children admitted to PICU following biventricular surgical repair of complete atrioventricular septal defect from January 2004 to December 2009.
Interventions:
None.
Measurements And Main Results:
A total of 107 children, 67 with Down syndrome, were included. Children with Down syndrome were operated earlier: 4 months (interquartile range, 3.5-6.6) versus 5.7 months (3-8.4) for Down syndrome and non-Down syndrome groups, respectively (p < 0.01). There was no early postoperative mortality. There was no significant difference in the prevalence of dysplastic atrioventricular valve between the two groups. Two children (2.9%) from Down syndrome and three children (7.5%) from non-Down syndrome group required early reoperation (p = 0.3). Junctional ectopic tachycardia was the most common arrhythmia, and the prevalence of junctional ectopic tachycardia was similar between the two groups (9% and 10% in Down syndrome and non-Down syndrome, respectively, p = 1). One patient from each group required insertion of permanent pacemaker for complete heart block. Children with Down syndrome had significantly higher prevalence of noncardiac complications, that is, pneumothorax, pleural effusions, and infections (p < 0.01), than children without Down syndrome. There was a trend for longer duration of mechanical ventilation in children with Down syndrome (41 hr [20-61 hr] vs 27.5 hr [15-62 hr], p = 0.2). However, there was no difference in duration of PICU stay between the two groups (2 d [1.3-3 d] vs 2 d [1-3 d], p = 0.9, respectively).
Conclusions:
In our study, we found no difference in the prevalence of atrioventricular valve dysplasia between children with and without Down syndrome undergoing complete atrioventricular septal defect repair. This finding contrasts with previously published data, and further confirmatory studies are required. Although clinical outcomes were similar, children with Down syndrome had a significantly higher prevalence of noncardiac complications in the early postoperative period than children without Down syndrome.
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