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Long-term outcomes after surgical repair of complete atrioventricular septal defect
Salil Ginde1, Janna Lam1, Garick D Hill1
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis.
Insights
Long-term survival after surgical repair of complete atrioventricular septal defect (CAVSD) is good. However, reoperation for valve issues or outflow obstruction is common and impacts survival.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Congenital Heart Disease
Background:
- Surgical repair of complete atrioventricular septal defect (CAVSD) has improved survival rates.
- Patients undergoing CAVSD repair remain at risk for reoperation due to valve regurgitation and outflow tract obstruction.
Purpose of the Study:
- To examine long-term survival after CAVSD repair.
- To assess the need for reoperation and associated risk factors.
- To evaluate outcomes in patients with CAVSD.
Main Methods:
- Retrospective review of 198 patients who underwent CAVSD repair between 1974 and 2000.
- Analysis of long-term follow-up data for 153 patients (86% of survivors).
- Evaluation of survival, reoperation rates, and risk factors.
Main Results:
- Overall perioperative mortality was 10.1%, decreasing to 2.9% in the later surgical era (1991-2000).
- Estimated survival was 85% at 10 years, 82% at 20 years, and 71% at 30 years post-repair.
- Reoperation was a risk factor for late mortality; freedom from reoperation was 88% at 10 years and 78% at 30 years. Common indications included left atrioventricular valve regurgitation and left ventricular outflow obstruction.
Conclusions:
- Long-term survival following CAVSD repair is favorable.
- The need for reoperation is a significant factor affecting long-term outcomes in CAVSD patients.
Objective:
Survival after surgical repair for complete atrioventricular septal defect (CAVSD) has improved, but patients are at risk for reoperation to address left atrioventricular valve regurgitation and left ventricular outflow tract obstruction. We examined the long-term survival, need for reoperation, and associated risk factors after CAVSD repair at our institution.
Methods:
Between 1974 and 2000, a total of 198 patients underwent surgical repair for CAVSD. Of these, 178 patients survived to hospital discharge, of whom 153 (86%) had available follow-up data at a median postoperative time point of 17.2 years (range: 2 months to 38.1 years).
Results:
Overall perioperative mortality was 10.1%, with a significant decrease to 2.9% in the late surgical era: 1991 to 2000 (P < .001). The overall estimated survival for the entire cohort was 85% at 10 years, 82% at 20 years, and 71% at 30 years after initial CAVSD repair. Requiring a reoperation after initial CAVSD repair was a risk factor for late mortality (P = .04). The estimated freedom from reoperation was 88% at 10 years, 83% at 20 years, and 78% at 30 years after initial CAVSD repair. Indications for reoperation included left atrioventricular valve regurgitation in 14 patients (7.1%) and left ventricular outflow obstruction in 7 patients (3.5%).
Conclusions:
Long-term survival after repair of CAVSD remains good. However, the need for reoperation is common and affects long-term survival after CAVSD repair.
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