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Twelve Years of Complete Atrioventricular Septal Defect Repair
André Sena1, Ventsislav Sheytanov2, Markus Liebrich2
1Department of Cardiothoracic surgery, Hospital de Santa Maria, Lisbon, Portugal.
Insights
Surgical repair of complete atrioventricular septal defect (AVSD) yields good outcomes regardless of technique. Most children achieve excellent functional status with low rates of complications like valve insufficiency or pulmonary hypertension.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Medical Device Technology
Background:
- Complete atrioventricular septal defect (AVSD) is a congenital heart condition requiring surgical intervention.
- Standard surgical repair techniques include single patch, modified single patch, and two patch methods.
- Surgeon preference and defect anatomy dictate the chosen surgical approach.
Purpose of the Study:
- To evaluate the outcomes of surgical repair for complete AVSD over a 12-year period.
- To compare the efficacy of different surgical techniques for complete AVSD repair.
- To assess the incidence of complications and long-term functional status post-repair.
Main Methods:
- Retrospective analysis of 81 children undergoing complete AVSD repair from June 2006 to June 2018.
- Exclusion criteria included tetralogy of Fallot and unbalanced ventricles.
- Data collected included patient demographics, surgical technique, and clinical outcomes at discharge and follow-up.
Main Results:
- 84% of patients had Down syndrome; 80% were symptomatic at presentation.
- Low rates of significant atrioventricular valve insufficiency (84% at discharge, 89% at follow-up).
- 27% had residual defects at discharge, with 41% closing spontaneously; 90% achieved NYHA class I at follow-up.
Conclusions:
- Surgical repair of complete AVSD achieves favorable early and midterm results.
- The choice of surgical technique did not significantly impact main repair outcomes.
- Good functional status and acceptable complication rates were observed across all techniques.
Background:
Surgical repair is the standard treatment for complete atrioventricular septal defect. At our institution, this repair is performed by single patch, modified single patch or two patch techniques, according to the surgeon preferences and the surgical anatomy of the defect. The goal of this study was to evaluate our results from the last twelve years.
Methods:
From June 2006 to June 2018, 81 children with complete atrioventricular septal defect (without tetralogy of Fallot or unbalanced ventricles) were submitted to surgical repair at our institution. Data from all patients was retrospectively collected and evaluated.
Results:
The average age was 6.9 ± 13.7 months and 84% had Down syndrome. Eighty percent were symptomatic and 6 patients were previously submitted to pulmonary artery banding. No more that mild left atrioventricular valve insufficiency was found in 84% and 89% of the patients, at discharge and follow-up, respectively. Small residual septal defects were present in 27% at discharge; during follow-up, 41% of these closed spontaneously. Pulmonary hypertension at discharge and follow-up appeared in 3.7% and 1.3%, respectively. Permanente pacemaker was implanted in 3 patients. Left ventricle outflow tract obstruction was found in 3 patients and 2 needed surgical correction. At follow-up (40 ± 38 months), 90% of the patients presented NYHA functional class I. No significant differences in the main repair outcomes were found between techniques, with the exception of small residual septal defects, although the groups were unmatched.
Conclusions:
Overall and regardless of the technique used for the repair of complete AVSD, good early and midterm outcomes were achieved.
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