Repair of the complete atrioventricular septal defect-impact of postoperative moderate or more regurgitation

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Complete atrioventricular septal defect (cAVSD) is a complex congenital heart defect requiring surgical intervention.
• Postoperative outcomes after cAVSD repair are influenced by various factors, including valve function.

Purpose of the Study:

• To identify risk factors for mortality, moderate or greater left atrioventricular valve regurgitation (LAVVR), and reoperation after cAVSD surgical repair.
• To analyze the impact of immediate postoperative LAVVR on long-term survival.

Main Methods:

• Retrospective review of 220 patients undergoing cAVSD repair between 2000 and 2021.
• Exclusion of patients with unbalanced ventricles, double outlet right ventricle, and malpositioned great arteries.
• Univariate and multivariable Cox regression and Fine-Gray modeling for outcome predictors; Kaplan-Meier and cumulative incidence curves for time-dependent endpoints.

Main Results:

• Overall mortality was 14.2% (operative 4.6%, late 9.6%) over a median follow-up of 2.3 years.
• Moderate or greater LAVVR immediately post-surgery was present in 26 patients, with 10 later deaths.
• Multivariable analysis identified prematurity and immediate moderate/severe LAVVR as predictors of overall mortality.

Conclusions:

• Postoperative residual LAVVR is a significant burden after cAVSD repair, contributing substantially to mortality.
• Patients with immediate moderate or greater LAVVR exhibit significantly lower survival rates.
• Further investigation is warranted to determine if a second bypass procedure can mitigate this increased mortality.