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Repair of complete atrioventricular canal defects: results with the two-patch technique
C L Backer1, C Mavroudis, E T Alboliras
1Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, Illinois 60614, USA.
Insights
Repair of complete atrioventricular canal defect in infants using the two-patch technique with mitral valve cleft closure shows excellent outcomes. This study highlights low operative mortality and reduced need for reoperation for mitral insufficiency.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiac Surgery
Background:
- Complete atrioventricular canal (CAVC) defect is a complex congenital heart condition.
- Surgical repair of CAVC defects in infants and children is critical for long-term outcomes.
- The two-patch technique with routine mitral valve cleft closure has been utilized for CAVC repair.
Purpose of the Study:
- To evaluate the efficacy and outcomes of the two-patch technique for complete atrioventricular canal defect repair.
- To assess the impact of routine mitral valve cleft closure on patient results.
- To analyze survival rates, reoperation rates, and complications in a cohort of pediatric patients.
Main Methods:
- Retrospective review of 115 infants and children undergoing complete atrioventricular canal defect repair.
- Analysis of patient demographics, preoperative cardiac catheterization data, and associated anomalies.
- Evaluation of operative survival, late mortality, and incidence of complications such as heart block and mitral insufficiency.
Main Results:
- Operative survival rate was 94% with an overall survival rate of 91%.
- A low incidence of heart block (3.5%) and mitral insufficiency (7%) requiring reoperation was observed.
- No patient required reoperation for residual ventricular septal defect; 6 of 8 patients with mitral insufficiency had successful cleft repair.
Conclusions:
- The two-patch technique with routine mitral valve cleft closure is effective for complete atrioventricular canal defect repair in infants.
- Optimal repair timing at 4 to 6 months of age is associated with favorable outcomes.
- This surgical approach leads to low operative mortality, low rates of heart block, and infrequent reoperations for mitral insufficiency.
Background:
Between 1983 and 1994, 115 infants and children underwent repair of a complete atrioventricular canal defect with the two-patch technique and routine mitral valve "cleft" closure.
Methods:
A retrospective review of these 115 patients was performed. Age at the time of repair ranged from 1 month to 108 months (mean age, 14.2 +/- 16.5 months; median age, 8 months). Preoperative cardiac catheterization in 113 patients revealed a mean pulmonary to systemic flow ratio of 3.37 +/- 1.8, a mean pulmonary artery systolic pressure of 71.1 +/- 15.7 mm Hg, and a mean pulmonary vascular resistance of 4.9 +/- 3.3 units. Associated anomalies included Down's syndrome (99 patients), patent ductus arteriosus (47), and coarctation of the aorta (4). Rastelli classification was A (76 patients), B (10), C (24), and unknown (5). Twenty-four patients had intraoperative epicardial or transesophageal echocardiography.
Results:
Although there was a trend toward increasing mean preoperative pulmonary vascular resistance with age from 2.1 +/- 0.9 units (0 to 3 months) to 4.0 +/- 2.6 units (4 to 6 months) to 5.7 +/- 3.0 units (7 to 12 months), the mean pulmonary vascular resistance of each age group was not significantly different from that of the main group. The operative survival rate was 94% (seven early deaths) and the overall survival rate, 91% (three late deaths). Intraoperative echocardiography altered the surgical therapy for 1 patient. No patient has required reoperation for a residual ventricular septal defect. Four patients (3.5%) had heart block requiring permanent pacemakers. Eight patients (7%) required reoperation for mitral insufficiency; 6 of whom had successful repair of a residual cleft.
Conclusions:
For infants with complete atrioventricular canal defect, repair using the two-patch technique with routine mitral valve cleft closure at 4 to 6 months of age results in a low operative mortality, a low incidence of permanent heart block, and a low reoperation rate for mitral insufficiency.