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Surgical Outcomes in Children With Partial and Transitional Atrioventricular Septal Defect
Yuki Nakayama1, Takeshi Shinkawa1, Ryogo Hoki1
1Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo, Japan.
Insights
Long-term outcomes for partial and transitional atrioventricular septal defect repair are good. However, infant repair increases mortality, and valve regurgitation after repair predicts reoperation, impacting survival in children with atrioventricular septal defects.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Atrioventricular Septal Defect Repair
Background:
- Partial and transitional atrioventricular septal defects (AVSDs) are congenital heart conditions requiring surgical intervention.
- Long-term outcomes and risk factors for reoperation, particularly concerning the atrioventricular valve, require further investigation.
Purpose of the Study:
- To evaluate the long-term results of surgical repair for partial and transitional atrioventricular septal defects.
- To identify factors associated with patient survival and the need for left atrioventricular valve reoperation.
Main Methods:
- Retrospective review of 104 children undergoing partial or transitional AVSD repair (1983-2021).
- Analysis of patient survival and left atrioventricular valve reoperation rates.
- Multivariable analysis to determine risk factors for mortality and reoperation.
Main Results:
- Overall survival was high (93.0% at 20 years), but infant repair (<1 year) was linked to significantly higher mortality (35.3% vs 1.5%).
- 15.4% of patients required left atrioventricular valve reoperation.
- Moderate-to-severe left atrioventricular valve regurgitation post-repair and incomplete cleft closure were associated with reoperation.
Conclusions:
- Partial and transitional AVSD repair generally yields satisfactory long-term outcomes.
- Infancy repair is a risk factor for worse survival.
- Post-repair atrioventricular valve regurgitation necessitates reoperation and impacts long-term results.
Background:
This study aimed to evaluate the long-term outcomes of partial and transitional atrioventricular septal defect repair, focusing on left atrioventricular valve reoperation.
Methods:
We conducted a retrospective review of 104 children who underwent partial or transitional atrioventricular septal defect repair between August 1983 and January 2021. The major outcomes included patient survival and left atrioventricular valve reoperation.
Results:
Median age at repair was 4.0 (0.1-17.0) years, with 17 patients being infants (age ≤ 1 year; 16.3%). All but eight patients (92.3%) underwent left atrioventricular valve cleft closure. After initial repair, there were 18 cases of moderate-to-severe left atrioventricular valve regurgitation (17.3%). Three in-hospital deaths (2.9%) and four late deaths (3.8%) occurred. At follow-up (median 14.3 years), actuarial survival was 95.1% and 93.0% at 1 and 20 years, respectively, and 16 patients (15.4%) had undergone a total of 19 left atrioventricular valve reoperations. Initial repair performed during infancy was associated with significantly higher mortality than a repair performed after infancy (35.3% vs 1.5%, P < .01, hazard ratio = 26.4). On multivariable analysis, repair during infancy was associated with mortality (P < .01, hazard ratio = 27.4, 95% confidence interval = 2.7-283). Partial or no cleft closure of left atrioventricular valve (P = .03, hazard ratio = 4.7, 95% confidence interval = 1.2-18.8) and moderate-to-severe left atrioventricular valve regurgitation after repair (P < .01, hazard ratio = 9.9, 95% confidence interval = 3.0-32.2) were associated with left atrioventricular valve reoperation.
Conclusions:
Partial and transitional atrioventricular septal defect repair outcomes were generally satisfactory. However, repair during infancy had worse survival outcomes, and moderate-to-severe left atrioventricular valve regurgitation after a repair was associated with future left atrioventricular valve reoperation.
