A 27-Year Experience with Atrioventricular Septal Defect Correction
Mina Farag1, Mireia Isern Hacker1, Philippe Grieshaber1
1Department of Cardiac Surgery, Division of Congenital Cardiac Surgery, Heidelberg University, Congenital, Heidelberg, Germany.
The Thoracic and Cardiovascular Surgeon
|March 28, 2025
Summary
Long-term survival after surgical correction of atrioventricular septal defect (AVSD) is favorable and has improved over time. Key risk factors for mortality include prematurity and low weight at repair.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Atrioventricular septal defect (AVSD) is a complex congenital heart defect requiring surgical intervention.
- Long-term outcomes following biventricular repair of AVSD are crucial for patient management.
- Understanding risk factors for mortality and reoperation is essential for improving surgical results.
Purpose of the Study:
- To investigate the long-term outcomes, including survival and reoperation rates, after surgical correction of atrioventricular septal defect (AVSD).
- To identify independent risk factors associated with mortality and reoperation following AVSD repair.
- To evaluate the impact of different AVSD types and surgical eras on patient outcomes.
Main Methods:
- Retrospective analysis of 248 patients undergoing biventricular repair for AVSD between 1995 and 2022.
- Classification of AVSD into complete, partial, and transitional types.
- Statistical analysis to determine survival rates, reoperation incidence, and risk factors for adverse outcomes.
Main Results:
- Overall survival was 88.3% at 10 years, 83.8% at 15 years, and 79.6% at 25 years, with significant improvement over surgical eras.
- Independent risk factors for mortality included prematurity (HR: 2.43) and low weight (<4kg) (HR: 3.05).
- Reoperation incidence was 19.4%, with left atrioventricular valve regurgitation (LAVVR) being the primary indication; freedom from reoperation was 78.2% at 10 years.
Conclusions:
- Biventricular repair of AVSD offers favorable long-term survival, which has improved significantly with advancements in surgical techniques.
- Prematurity, low weight at repair, and early postoperative LAVVR are critical factors influencing mortality and reoperation rates.
- Close postoperative follow-up is recommended for premature infants and those with associated cardiovascular anomalies to mitigate risks.
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