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[Surgical treatment of complete atrioventricular canal. Value of the "composite double patch" technic]
1Service de chirurgie thoracique et cardiaque, Hôpital cardio-vasculaire et pneumologique Louis-Pradel, Lyon.
Insights
This study reports on 49 complete atrioventricular canal corrections in children, with a 35% overall mortality. The "composite double patch" technique showed a 20% mortality, highlighting improved outcomes in pediatric cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects
- Atrioventricular Canal Defect
Context:
- Complete atrioventricular canal (CAVC) is a complex congenital heart defect requiring surgical intervention.
- Surgical outcomes for CAVC in infants and children have historically been challenging.
- This study reviews surgical techniques and outcomes for CAVC correction between 1982 and 1988.
Purpose:
- To evaluate the outcomes of complete atrioventricular canal correction in a pediatric population.
- To assess the efficacy and safety of the "composite double patch" technique.
- To analyze mortality rates and identify factors influencing surgical success.
Summary:
- 49 children underwent CAVC correction, with 41 being infants under two years old.
- The "composite double patch" technique was employed in 35 patients, involving dacron and pericardial patches.
- Overall mortality was 35%, with higher rates in younger infants (under 1 year: 23%). The "composite double patch" technique had a 20% mortality.
- Early mortality decreased in the latter part of the study, with only one death in the last 15 patients.
- Follow-up revealed residual mitral regurgitation in 14 patients, necessitating ongoing monitoring.
Impact:
- The study highlights the significant mortality associated with CAVC repair in infants.
- The "composite double patch" technique demonstrated a trend towards improved outcomes compared to earlier methods.
- Findings underscore the need for specialized pediatric cardiac surgical expertise and continuous technique refinement for complex congenital heart defects.
Abstract:
Between January 1, 1982 and January 1, 1988, 49 complete corrections of complete atrioventricular canal were performed in children aged from 4 months to 8 years. 41 were infants less than 2 years' old and 31 were less than one year old. In the last 35 patients the "composite double patch" technique was used, consisting of closure of the interventricular septal defect with a dacron patch, followed by closure of the ostium primum with a pericardial patch. The mitral cleft was left intact in the last 6 operations. The overall mortality rate was 35 p. 100 (17 patients). It was 23 p. 100 in infants under 1 year and 17 p. 100 in infants aged from 6 to 12 months at the time of surgery (p less than 0.01). Seven of the 35 children in whom the "composite double patch" technique was used died (20 p. 100). Only one early death was recorded among the last 15 children operated upon. Two reoperations were performed: one within one month of the first operation, the other 4 months later for residual mitral regurgitation with haemolysis. 32 children were followed up for periods of 2 months to 6 years, 10 of them for more than 3 years. Two late deaths occurred during the follow-up. Grade 2 or 3/4 residual regurgitation was found in 14 patients who have regular clinical and echocardiographic examinations.(ABSTRACT TRUNCATED AT 250 WORDS)