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Repair of partial atrioventricular septal defect: a 37-year experience
Edward Buratto1, Brian McCrossan2, John C Galati3
1Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia The University of Melbourne, Melbourne, Australia Murdoch Children's Research Institute, Melbourne, Australia igor.konstantinov@rch.org.au.
Insights
Surgical repair of partial atrioventricular septal defect (pAVSD) offers excellent long-term survival. However, a significant reoperation rate highlights the need for lifelong cardiac monitoring in pAVSD patients.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Congenital Heart Disease
Background:
- Partial atrioventricular septal defect (pAVSD) repair is a common procedure with low early mortality.
- Long-term outcomes and morbidity following pAVSD repair are not well-documented.
Purpose of the Study:
- To evaluate the long-term survival and morbidity in a large cohort of patients who underwent pAVSD repair.
- To identify factors influencing long-term outcomes after pAVSD surgery.
Main Methods:
- A retrospective analysis of 249 consecutive patients who underwent pAVSD repair between 1975 and 2012.
- Data collection included hospital records, physician correspondence, patient surveys, and death registries.
Main Results:
- Early mortality was 1.2%, with 30-year survival at 94%.
- Freedom from reoperation was 75% at 30 years, with common reoperations including valve surgery and outflow tract obstruction correction.
- Permanent pacemaker implantation was required in 3.2% of patients.
Conclusions:
- pAVSD repair is associated with excellent long-term survival.
- A substantial rate of reoperation necessitates ongoing cardiac follow-up into adulthood.
- Adherence to follow-up care decreases significantly in adult patients.
Objectives:
Partial atrioventricular septal defect (pAVSD) is routinely repaired with a low mortality. However, limited data are available on the long-term follow-up of these patients. The current study was designed to determine long-term survival and morbidity of a large cohort of patients operated on at a single institution.
Methods:
From 1975 to 2012, 249 consecutive patients underwent pAVSD repair at the Royal Children's Hospital. The follow-up data were obtained from hospital records, correspondence with cardiologists and primary care physicians, patient surveys and the state death registry.
Results:
The early mortality rate was 1.2% (3/249), while the long-term survival rate was 96% (95% CI: 93-98%) at 10 years and 94% (95% CI: 89-97%) at 30 years. Freedom from reoperation was 84% at 10 years and 75% at 30 years. The most common reoperations were left atrioventricular valve surgery (30/249, 12.1%), resection of left ventricular outflow tract obstruction (12/249, 4.8%) and closure of residual atrial septal defects (5/249, 2.0%). Implantation of a permanent pacemaker was required in 3.2% (8/249) of patients. Despite a substantial reoperation rate, only 43% of patients older than 18 years of age were seen by a cardiologist within the most recent 2 years of the study period, compared with 80% of those younger than 18 years (P < 0.001).
Conclusions:
Repair of pAVSD is performed with a low mortality and excellent long-term survival. However, a substantial reoperation rate warrants close follow-up into adulthood.
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