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Rethinking timing: Outcomes of late versus early surgical repair of complete atrioventricular septal defect in a
Andres F Jimenez1, Laura Sanchez1, Ivone Pineda1
1Department of Cardiovascular Surgery, Fundación Cardioinfantil - La Cardio, Bogotá, Colombia.
Insights
Delayed complete atrioventricular septal defect (CAVSD) repair in resource-limited settings showed comparable outcomes to early surgery. Flexible surgical timing may be feasible with strong perioperative support.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Global Health
Background:
- Complete atrioventricular septal defect (CAVSD) repair is ideally done before 6 months.
- Access barriers in resource-limited settings often delay CAVSD repair.
- Outcomes of delayed CAVSD repair are not well-established in these settings.
Purpose of the Study:
- To compare outcomes between early (<6 months) and late (≥6 months) surgical repair of CAVSD.
- To evaluate the impact of delayed repair on operative mortality, survival, and valve reintervention.
- To inform surgical timing strategies in resource-limited environments.
Main Methods:
- Retrospective cohort study of 111 patients undergoing primary CAVSD repair (2012-2022).
- Patients divided into early (n=22) and late (n=89) repair groups.
- Comparison of preoperative, intraoperative, and postoperative variables using statistical analyses.
Main Results:
- Late repair group had less favorable preoperative conditions, including lower oxygen saturation and higher rates of pulmonary hypertension and LAVV regurgitation.
- Operative mortality was similar between groups (5.6% late vs. 0% early, P=.58).
- Medium-term survival and freedom from left atrioventricular valve (LAVV) reintervention were comparable between early and late repair groups.
Conclusions:
- Delayed CAVSD repair in this cohort had comparable operative mortality and medium-term outcomes to early repair.
- Less favorable preoperative profiles in the late repair group did not translate to worse outcomes.
- Flexible surgical timing for CAVSD may be considered in resource-limited settings with robust perioperative care and follow-up.
Objective:
Complete atrioventricular septal defect (CAVSD) repair is ideally performed within the first 6 months of life; however, in resource-limited settings, access barriers often delay surgery We compared outcomes between early (<6 months) and late (≥6 months) surgical repair at a single reference center in Colombia.
Methods:
A retrospective cohort of 111 consecutive patients (2012-2022) undergoing primary CAVSD repair was analyzed. Patients were divided into early (n = 22) and late (n = 89) groups. Preoperative, intraoperative, and postoperative variables-including operative mortality, survival, and freedom from left atrioventricular valve (LAVV) reintervention-were compared using χ2, Mann-Whitney U, and Kaplan-Meier analyses.
Results:
Median age at surgery was 4.9 months (interquartile range, 4.5-5.4) for early versus 8.5 months (interquartile range, 7.2-14.3) for late repair. Trisomy 21 was present in 83.8%. The early group had greater preoperative oxygen saturation (P = .004), less prevalent moderate/severe pulmonary hypertension (P = .013), and less LAVV regurgitation (4.5% vs 43.9%, P = .003). Operative mortality was 4.5% overall (0% early vs 5.6% late, P = .58). The early group had longer intensive care unit (median 8 vs 6 days, P = .012) and hospital stays (median 21 vs 13 days, P = .006). Medium-term survival and freedom from LAVV reintervention were comparable (log-rank P > .05).
Conclusions:
In this cohort, later CAVSD repair yielded operative mortality and medium-term outcomes comparable with early repair despite less-favorable preoperative profiles. These findings may support flexible surgical timing in resource-limited settings with robust perioperative care and follow-up.
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