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Early Complete Atrioventricular Canal Repair Yields Outcomes Equivalent to Late Repair
Elizabeth H Stephens1, Ali N Ibrahimiye1, Halit Yerebakan1
1Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, New York.
Insights
Individualized surgical repair of complete atrioventricular canal in infants offers outcomes similar to older children. This approach for congenital heart defects may avoid delaying surgery for symptomatic young patients.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiac Anatomy
Background:
- Complete atrioventricular canal repair traditionally has higher risks in young infants.
- Individualized, anatomy-based repair may equalize outcomes for infants and older children.
Purpose of the Study:
- To evaluate the safety and efficacy of an individualized surgical approach for complete atrioventricular canal repair in infants.
- To compare outcomes between younger (<3 months) and older infants undergoing this repair.
Main Methods:
- Retrospective review of 139 patients undergoing complete atrioventricular canal repair (2005-2012).
- Individualized repair strategies: 2-patch for large VSDs, modified single-patch (Australian technique) for shallow VSDs.
- Analysis of perioperative data, mortality, reoperation rates, and risk factors.
Main Results:
- Average age 25.5 weeks; 78% had trisomy 21. In-hospital mortality 2.1%, late mortality 0.7%.
- Younger infants (<3 months) showed similar perioperative courses and reoperation rates compared to older infants.
- 2-patch repair was associated with trisomy 21 and longer bypass times but similar outcomes to the Australian technique.
Conclusions:
- Individualized complete atrioventricular canal repair provides comparable early mortality and reoperation rates for infants of all ages.
- This approach supports timely surgical intervention for symptomatic infants, regardless of age.
Background:
Repair of complete atrioventricular canal early in infancy has traditionally carried greater morbidity and mortality than repair performed later. However, an individualized anatomy-based repair may give young infants outcomes that are equivalent to older patients.
Methods:
We retrospectively reviewed 139 patients who underwent complete atrioventricular canal repair from January 2005 to December 2012. An individualized approach was used: 2-patch repair was performed in 98 patients for large ventricular septal defects and a modified single-patch ("Australian technique") was used in 41 for "shallow" ventricular septal defects.
Results:
The average age was 25.5 ± 3.9 weeks, 50% were boys, and 78% had trisomy 21. Mean follow-up was 5.1 ± 0.2 years, with 100% completeness of data. There were 3 in-hospital deaths (2.1%) and 1 late death (0.7%). A permanent pacemaker was required in 2 patients (1.4%). The rate for left atrioventricular valve reoperation was 8% at a mean of 211 ± 238 days after the original repair (range, 6 to 682 days). Compared with patients aged older than 3 months, the 39 patients (28%) who were younger than 3 months had similar perioperative courses and rate of reoperation. Compared with patients with an Australian repair, the 98 patients (71%) with a 2-patch repair were more likely to have trisomy 21 and had slightly increased cardiopulmonary bypass and cross-clamp times but similar outcomes. Multivariate analysis showed postoperative left atrioventricular valve regurgitation greater than 2 and left ventricular outflow tract obstruction were significant risk factors for reoperation on the left atrioventricular valve (both p < 0.05).
Conclusions:
Repair of complete atrioventricular canal using an individualized surgical approach yields reoperation and early mortality rates similar for younger infants compared with older infants, obviating the need to delay operation in symptomatic patients.
