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Propensity score matched analysis of partial atrioventricular septal defect repair in infancy
Edward Buratto1,2,3, Michael Daley2,4, Xin Tao Ye1
1Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Repairing partial atrioventricular septal defects (pAVSD) in infants leads to lower survival rates compared to older children. Elective pAVSD repair should be delayed until after infancy for better outcomes.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Medical Outcomes Research
Background:
- Partial atrioventricular septal defect (pAVSD) repair is typically done between 2-4 years with good results.
- Infant pAVSD repair has been linked to worse outcomes, but confounding factors like heart failure and valve regurgitation were present.
Purpose of the Study:
- To evaluate the impact of surgical timing on outcomes for pAVSD repair.
- To compare survival and reoperation rates in infants versus older children undergoing pAVSD repair.
Main Methods:
- A retrospective analysis of 430 children who underwent pAVSD repair across three institutions (1975-2015).
- Infants (<1 year) were compared to older children using propensity score matching based on clinical factors.
- Key matching variables included failure to thrive, congestive heart failure, LAVV regurgitation, associated defects, sex, and trisomy 21.
Main Results:
- Infants (17.4%) had higher rates of LAVV regurgitation, heart failure, and additional cardiac malformations.
- Thirty-year survival was 82.1% for infants versus 95.7% for older children (P<0.001).
- After propensity score matching, 30-year survival remained significantly lower for infants (87.9%) compared to older children (98.1%) (P=0.04), with no difference in reoperation rates.
Conclusions:
- Infant pAVSD repair is associated with significantly lower survival rates, even after accounting for risk factors.
- Reoperation rates were similar between infants and older children.
- Elective pAVSD repair should be deferred until after infancy to improve long-term survival.
Objective:
Partial atrioventricular septal defect (pAVSD) is usually repaired between 2 and 4 years of age with excellent results. Repair during infancy has been associated with poorer outcomes. However, most infants in reported series had heart failure or significant left atrioventricular valve (LAVV) regurgitation. The impact of surgery during infancy on outcomes remains unclear.
Methods:
All children at three institutions who underwent repair of pAVSD from 1975 to 2015 were included. Infants (aged <1 year) were compared with older children in a propensity score matched analysis. Variables used to generate propensity scores were: failure to thrive, congestive heart failure, preoperative LAVV regurgitation, associated congenital heart disease, sex and the presence of trisomy 21.
Results:
pAVSD repair was performed on 430 children, 17.4% (75/430) were infants. Infants (mean age 0.5±0.3 years) had higher rates of LAVV regurgitation, heart failure and additional cardiac malformations than older children (mean age 4.7±3.5 years). At 30 years, survival for infants was 82.1% (95% CI 70.1% to 89.6%) compared with 95.7% (95% CI 91.3% to 97.9%) in older children (P<0.001).Propensity score matching yielded 52 well-matched pairs. Survival at 30 years was 87.9% (95% CI 75.0% to 94.4%) for infants compared with 98.1% (95% CI 87.1% to 99.7%) for older children (P=0.04). There was no significant difference in freedom from reoperation between the groups.
Conclusions:
Despite matching for risk factors, survival after repair of pAVSD during infancy is lower than that when repair is performed in older children, with no difference in reoperation rates. This suggests that elective repair of pAVSD should be deferred until after infancy.
