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[Total repair of complete atrioventricular canal: relationship between age at operation and late results]
Insights
This study on complete atrioventricular canal (CAVC) repair shows significant reduction in pulmonary hypertension post-surgery. One-stage operations improved patient outcomes and growth, with low mortality rates.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Cardiovascular Physiology
Context:
- Complete Atrioventricular Canal (CAVC) is a complex congenital heart defect.
- Surgical intervention is crucial for managing CAVC, especially in infants and those with Down syndrome.
- Evaluating surgical techniques and outcomes is vital for improving patient care.
Purpose:
- To assess the efficacy of a one-stage surgical repair for complete atrioventricular canal (CAVC).
- To analyze perioperative and long-term outcomes, including mortality, pulmonary hypertension, and growth.
- To compare surgical techniques, specifically the single patch technique (SPT) versus the two-patch technique.
Summary:
- Twenty-five patients with CAVC underwent one-stage repair using cardiopulmonary bypass and moderate hypothermia.
- Postoperative pulmonary artery pressure, systolic pressure ratio, and vascular resistance index significantly decreased.
- While operative mortality was 8.0%, no hospital deaths occurred, and long-term follow-up showed improved patient growth and weight gain.
Impact:
- The one-stage surgical repair effectively reduces pulmonary hypertension in CAVC patients.
- Improved postoperative hemodynamics and growth indicate successful surgical management.
- The study highlights the feasibility and benefits of surgical correction for CAVC, informing future treatment strategies.
Abstract:
Twenty five consecutive patients with complete atrioventricular canal (CAVC) underwent one-stage operation from April 1981 to Aug. 1987. Average ages at operation was 18 months (2 to 72) and average weight was 7.0 kg (2.8 to 13.8). Fifteen patients were infants and fifteen had Down syndrome. Conventional cardiopulmonary bypass with pulsatile bypass pump (PBP) and moderate hypothermia at 28 degrees C was utilized in all patients. Single patch technique (SPT) was adopted for initial five patients and two patch technique for the latter twenties. Two patients died perioperatively (operative mortality 8.0%), one of whom from mitral stenosis after SPT and the other from misdiagnosis of large subpulmonary VSD. There was no hospital death. Mean pulmonary artery pressure (mPA), pulmonary systolic pressure to systemic systolic pressure ratio (Pp/Ps) and pulmonary vascular resistance index (PVRI) were decreased remarkably from preoperative values of 56 +/- 14 mmHg, 0.92 +/- 0.13 and 6.2 +/- 4.9 WU.m2 to postoperative of 31 +/- 16 mmHg (p less than 0.001), 0.54 +/- 0.20 (p less than 0.001) and 4.6 +/- 4.0 WU.m2 (NS), respectively. Six patients had residual pulmonary hypertension in which mPA was more than 40 mmHg. One patient who was complicated with severe mitral regurgitation due to dehiscence of suture line and torn chordae had mitral valve replacement. Mean follow-up period was 26 months (5 to 63). The mean weights of 67%N at operation catched up with 87%N 3 years after operation. There were two late deaths, 4 and 20 months after operation between age at operation, both of whom had residual pulmonary hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)