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Published on: February 8, 2022
Propensity Score Matched Analysis of Cleft Closure in Complete Atrioventricular Septal Defect Repair
Edward Buratto1, Adrienne Lui2, Thomas Hu3
1Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia.
Insights
Closing the left atrioventricular valve (LAVV) cleft during complete atrioventricular septal defect (cAVSD) repair does not impact reoperation rates. This study found similar long-term outcomes whether the cleft was closed or not.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Defects
Background:
- Complete atrioventricular septal defect (cAVSD) repair has low mortality but high rates of reoperation, often linked to the left atrioventricular valve (LAVV) cleft.
- The impact of LAVV cleft closure on reoperation risk after cAVSD repair is not well-established through rigorous trials.
Purpose of the Study:
- To investigate the effect of LAVV cleft closure on patient outcomes following cAVSD repair.
- To determine if closing the LAVV cleft influences the need for reoperation after cAVSD surgery.
Main Methods:
- A retrospective review of 455 patients who underwent cAVSD repair from 1990 to 2019.
- Propensity score matching was employed to compare outcomes between patients with and without LAVV cleft closure, controlling for reoperation risk factors.
Main Results:
- Propensity score matching identified 106 pairs of patients. No significant differences in long-term survival (P = .71) or reoperation rates (P = .26) were observed between the groups.
- Key risk factors for reoperation included preoperative severe LAVV regurgitation and early postoperative moderate or greater LAVV regurgitation. Trisomy 21 and recent surgical era were protective.
Conclusions:
- cAVSD repair offers low mortality and good long-term survival.
- Similar freedom from reoperation can be achieved regardless of whether the LAVV cleft is closed during cAVSD repair.
Background:
Repair of complete atrioventricular septal defect (cAVSD) is achieved with low mortality. However, there is a high rate of reoperation on the left atrioventricular valve (LAVV), which is often attributed to nonclosure of the cleft. Although nonclosure of the cleft has been reported to be a risk factor for reoperation, no randomized controlled or propensity-matched trials have ever been performed. We investigated the effect of cleft closure on outcomes after cAVSD repair.
Methods:
We reviewed 455 patients who underwent cAVSD repair between 1990 and 2019. To determine the effect of cleft closure, propensity score matching was performed on risk factors for reoperation after cAVSD repair.
Results:
Median age was 3.6 months (mean, 9.6 ± 20.4 months), median weight was 4.3 kg (mean, 4.7 ± 4.3 kg) and 41.9% (191 of 455) were male. Early mortality was 2.9% (13 of 455), and survival was 89.8% ± 1.9% at 20 years. Early reoperation was a risk factor for mortality (P = .004). Freedom from reoperation was 72.5% ± 4.0% at 20 years. Freedom from LAVV reoperation was 74.1% ± 4.0% at 20 years. Preoperative severe LAVV regurgitation (P < .001) and early postoperative moderate or greater LAVV regurgitation (P = .007) were risk factors for reoperation, while trisomy 21 (P = .03) and recent era of surgery (P = .02) were protective. Propensity score matching yielded 106 pairs. There were no differences in long-term survival (P = .71) or reoperation (P = .26) between the 2 groups.
Conclusions:
Repair of cAVSD can be achieved with low mortality and good long-term survival, although the reoperation rate remains high. Similar freedom from reoperation can be achieved with or without closure of the LAVV cleft.
