Modified-Single Patch vs Double Patch Repair of Complete Atrioventricular Septal Defects.

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Complete atrioventricular septal defect (CAVSD) repair is crucial for pediatric cardiac patients.
• The double-patch (DP) and modified single-patch (MSP) techniques are current standards for biventricular repair.
• Long-term outcomes of the MSP technique for CAVSD repair require further definition.

Purpose of the Study:

• To compare long-term outcomes, including reoperation and mortality, after DP versus MSP repair of CAVSD.
• To identify risk factors associated with adverse outcomes following CAVSD repair.
• To evaluate the safety and efficacy of both DP and MSP techniques in CAVSD biventricular repair.

Main Methods:

• Retrospective cohort study of 273 patients undergoing CAVSD repair (120 DP, 153 MSP) between 1990 and 2015.
• Analysis of early (≤30 days) and late (>30 days) outcomes, including reoperation and mortality.
• Competing risks analysis using cumulative incidence functions for survival and reoperation rates.

Main Results:

• No significant difference in reoperation or mortality rates between DP and MSP repair techniques (P = 1.0 and P = 0.9, respectively).
• Cumulative incidence of reoperation at 15 years was 17% for DP and 16% for MSP.
• Non-Down syndrome and moderate/greater left atrioventricular valve regurgitation predicted reoperation; pulmonary artery banding predicted mortality.

Conclusions:

• Both DP and MSP techniques demonstrate similar long-term event-free survival for CAVSD repair.
• Either repair technique can be safely utilized for biventricular repair of CAVSD.
• Risk factors for reoperation and mortality are identifiable, aiding in patient management.