Related Experiment Video
Updated: Aug 28, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Timing of surgical repair and resource utilisation in infants with complete atrioventricular septal defect
Brock A Karolcik1, Sri O Rao2, Jon F Lucas3
1Department of Pediatrics, Medical University of South Carolina Children's Hospital, Charleston, SC, USA.
Insights
The timing of surgery for complete atrioventricular septal defect repair does not impact clinical outcomes or resource use in the first year of life. This study found no significant differences in days alive and out of the hospital for infants undergoing repair at different ages.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Health Services Research
Background:
- Timing of surgical repair for balanced complete atrioventricular septal defect (CAVSD) varies among centers.
- Understanding the impact of repair timing on early outcomes is crucial for clinical decision-making.
Purpose of the Study:
- To investigate the association between the timing of CAVSD repair and resource utilization and clinical outcomes within the first year of life.
- To determine if earlier or later surgical intervention influences patient recovery and healthcare resource use.
Main Methods:
- Retrospective single-center cohort study of 79 infants undergoing CAVSD repair (2005-2019).
- Exclusion criteria included outflow tract obstruction and major non-cardiac comorbidities (except trisomy 21).
- Primary outcome: days alive and out of the hospital in the first year of life; secondary outcomes included post-operative ICU days, mechanical ventilation, reinterventions, and clinic visits.
Main Results:
- No significant differences in days alive and out of the hospital were observed across age tertiles at surgery (median 351-354 days).
- Fewer intensive care unit (ICU) days were noted in the oldest surgical group, but mechanical ventilation and hospitalization durations were similar.
- Clinical outcomes, including unplanned reinterventions and outpatient visits, and weight-for-age z-scores at 1 year were comparable across all groups.
Conclusions:
- The age at which balanced complete atrioventricular septal defect repair is performed does not appear to be associated with significant differences in clinical outcomes or resource utilization in the first year post-operatively.
- These findings suggest flexibility in surgical timing may be possible without compromising early infant outcomes.
Introduction:
Variation exists in the timing of surgery for balanced complete atrioventricular septal defect repair. We sought to explore associations between timing of repair and resource utilisation and clinical outcomes in the first year of life.
Methods:
In this retrospective single-centre cohort study, we included patients who underwent complete atrioventricular septal defect repair between 2005 and 2019. Patients with left or right ventricular outflow tract obstruction and major non-cardiac comorbidities (except trisomy 21) were excluded. The primary outcome was days alive and out of the hospital in the first year of life.
Results:
Included were 79 infants, divided into tertiles based on age at surgery (1st = 46 to 137 days, 2nd = 140 - 176 days, 3rd = 178 - 316 days). There were no significant differences among age tertiles for days alive and out of the hospital in the first year of life by univariable analysis (tertile 1, median 351 days; tertile 2, 348 days; tertile 3, 354 days; p = 0.22). No patients died. Fewer post-operative ICU days were used in the oldest tertile relative to the youngest, but days of mechanical ventilation and hospitalisation were similar. Clinical outcomes after repair and resource utilisation in the first year of life were similar for unplanned cardiac reinterventions, outpatient cardiology clinic visits, and weight-for-age z-score at 1 year.
Conclusions:
Age at complete atrioventricular septal defect repair is not associated with important differences in clinical outcomes or resource utilisation in the first year of life.
