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Development of the Heart

The development of the human heart, a crucial organ, commences from the mesoderm on the 18th or 19th day after fertilization. This process initiates in the cardiogenic area, a group of mesodermal cells at the embryo's head end, which evolves into elongated strands known as cardiogenic cords. These cords undergo a transformation to form hollow-centered endocardial tubes.
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A 27-Year Experience with Atrioventricular Septal Defect Correction.

Mina Farag1, Mireia Isern Hacker1, Philippe Grieshaber1

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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.

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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.