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The repair of atrioventricular septal defects in infancy
Insights
Primary repair of atrioventricular septal defects in the first year of life is advisable. This approach offers high survival rates for both partial and complete defects, continuing a positive trend in pediatric cardiac surgery.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiac Surgery Outcomes
Background:
- Atrioventricular septal defects (ASDs) are congenital heart conditions requiring surgical intervention.
- Previous studies have analyzed outcomes for ASD repair, establishing trends over time.
- Assessing current mortality and survival rates is crucial for guiding treatment strategies.
Purpose of the Study:
- To evaluate the hospital mortality rates for atrioventricular septal defect (AVSD) repair between 1984 and 1985.
- To compare current outcomes with historical data from 1967-1982.
- To determine the advisability of primary repair in the first year of life for AVSD patients.
Main Methods:
- Retrospective analysis of 72 patients undergoing AVSD repair from 1984 to September 1985.
- Comparison of mortality data between isolated and complex AVSD cases.
- Analysis of outcomes based on age at repair, specifically focusing on infants under one year old.
Main Results:
- Overall hospital mortality was 3% (2/72) for AVSD repair; for isolated AVSD, it was 2% (1/58).
- Mortality for isolated AVSD repair in the first year of life was 3% (1/30).
- Hospital mortality rates remained consistent with earlier trends, showing a decrease for patients with major associated cardiac anomalies (7% in the current era).
Conclusions:
- The continuity of results between the two eras provides confidence in current surgical outcomes.
- Primary repair within the first year of life is recommended for most patients with atrioventricular septal defects.
- Predicted 10-year survival rates are high: 99% for partial AVSD and 95% for complete AVSD.
Abstract:
Two (3%) of 72 patients undergoing repair of atrioventricular septal defects, 1984-September 1985, died in hospital, and among the 58 patients with isolated atrioventricular septal defect, one (2%) died in hospital. One (3%) of the 30 patients with isolated atrioventricular septal defects undergoing repair in the first year of life died. The absence of an incremental risk of young age is a continuation of the trend demonstrated in a parametric analysis of the earlier 1967-1982 experience (n = 310). The hospital mortalities were similar in 1984-September 1985 after repair of partial and complete atrioventricular septal defects, again a continuation of the earlier trend as is the lessened hospital mortality (7%) in the current era among patients with major associated cardiac anomalies. The continuity of results in the two eras, and the predictability of the results in the current era from equations developed from the earlier one, give a high degree of confidence in the inference that primary repair in the first year of life is advisable for most patients with atrioventricular septal defects. Ten-year survival of such patients operated upon currently is predicted to be 99 and 95% for partial and complete atrioventricular septal defects, respectively.