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Intraoperative predictors of left atrioventricular valve reoperation after repair of complete atrioventricular septal

Edward Buratto1, Michael M H Cheung2, Vignesh Ratnaraj3

  • 1Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.

The Journal of Thoracic and Cardiovascular Surgery
|September 4, 2025
PubMed

Insights

Moderate or greater left atrioventricular valve regurgitation (LAVVR) and eccentric jets on intra-operative echocardiograms predict the need for reoperation after complete atrioventricular septal defect (cAVSD) repair. A second bypass run can improve LAVVR.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Surgery
  • Echocardiography

Background:

  • Complete atrioventricular septal defect (cAVSD) repair outcomes have improved, but left atrioventricular valve (LAVV) reoperation remains a concern.
  • Predicting the need for LAVV reoperation is crucial for optimizing surgical decision-making in cAVSD repair.

Purpose of the Study:

  • To identify intra-operative echocardiographic predictors of LAVV reoperation following cAVSD repair.
  • To evaluate the impact of a second bypass run on LAVV regurgitation (LAVVR) severity.

Main Methods:

  • Retrospective review of 134 patients undergoing cAVSD repair from 2010-2020.
  • Individual review of intra-operative post-bypass echocardiograms to assess LAVVR.
  • Long-term follow-up data collected from medical records.

Main Results:

  • 20.1% of patients had moderate or greater LAVVR post-first bypass.
  • A second bypass run improved mean LAVVR grade (2.2 to 1.3, p=0.004) and was performed in 8.2% of patients.
  • 10-year freedom from LAVV reoperation was significantly lower for moderate LAVVR (61.2%) and eccentric jets (65.4%) compared to no/mild LAVVR (89.6%) and central jets (92.7%).

Conclusions:

  • Moderate or greater LAVVR and eccentric LAVVR jets on intra-operative echocardiograms are significant predictors of reoperation.
  • A second bypass run for LAVV re-repair is effective in improving LAVVR severity.
  • Intra-operative echocardiographic findings can guide surgical decisions regarding LAVV re-repair during cAVSD surgery.
Abstract

Keywords:
atrioventricular septal defectleft atrioventricular valvereoperation

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