Optimal management of patients with complete atrioventricular septal defect

Controversy still persists as to whether patients with complete atrioventricular septal defect should be treated by primary total correction or a two-stage approach utilizing initial pulmonary artery banding. We believe a selected management program dictated by each individual patient's anatomy, presentation (size and preoperative functional class), and associated anomalies should be practiced, but with a strong preference toward initial total repair incorporating modern techniques to construct left and right atrioventricular valves, correct valvular incompetence, and close ventricular and atrial defects. Utilizing this management program, 23 consecutive patients (age 5 days to 51 months) with complete forms of atrioventricular septal defect were surgically corrected from July 1, 1984 through June 30, 1988. Fourteen patients were 12 months of age or less at the time of complete repair. Five patients (22%) had initial pulmonary artery banding, but only 2 were performed by us. Both had very extenuating circumstances making complete repair inappropriate. Only 2 of these 23 patients having complete repair died (hospital mortality 9%) and one had pulmonary artery banding 3 years previously. Of the 5 patients with initial pulmonary artery banding, 3 (60%) required right ventricular outflow tract reconstruction and/or repair of pulmonary artery bifurcation stenosis. We believe these good results support our continued practice of selective management of patients with complete forms of atrioventricular septal defect, but we maintain a strong preference toward initial complete repair.