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Partial atrioventricular canal defect: long-term follow-up after initial repair in patients > or = 40 years old
M L Bergin1, C A Warnes, A J Tajik
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Insights
Repairing partial atrioventricular (AV) canal in patients over 40 years old is safe and effective. Long-term outcomes show good survival and symptom improvement, though rare late complications necessitate follow-up.
Area of Science:
- Cardiovascular Surgery
- Adult Congenital Heart Disease
- Cardiac Repair Outcomes
Background:
- Outcomes of partial atrioventricular (AV) canal repair in younger patients are well-established.
- Data on the long-term results of this procedure in older adults (≥40 years) is limited.
- Understanding outcomes in this demographic is crucial for comprehensive patient care.
Purpose of the Study:
- To evaluate the results of surgical repair for partial atrioventricular (AV) canal defects in patients aged 40 years and older.
- To assess the safety, efficacy, and long-term outcomes of this intervention in an older patient cohort.
- To identify potential late complications and determine the need for ongoing monitoring.
Main Methods:
- A retrospective review of 31 patients aged 40-71 years who underwent partial AV canal repair between 1958 and 1990.
- Surgical interventions included cleft mitral valve repair (23 patients), mitral valve replacement (2 patients), and no mitral valve procedure (6 patients).
- Follow-up data was collected to assess mortality, morbidity, functional status, and late complications.
Main Results:
- Early mortality was 6%.
- Late complications observed in survivors included atrial arrhythmias, complete heart block, subaortic stenosis, and mitral regurgitation.
- Of 19 patients alive at mean 14-year follow-up, 15 reported sustained improvement, with 7 in NYHA functional class I.
Conclusions:
- Surgical repair of partial atrioventricular (AV) canal in patients aged 40 and older can be performed with low risk.
- Long-term survival is favorable, with significant subjective improvement in symptoms reported.
- While late complications are uncommon, they do occur, underscoring the importance of long-term patient follow-up.
Objectives:
This study was undertaken to determine the results of repair of partial atrioventricular (AV) canal in patients > or = 40 years old.
Background:
Although postoperative outcomes in younger patients have been well documented, the fate of older patients with repaired partial AV canal is less clear.
Methods:
From 1958 to 1990, 31 patients 40 to 71 years old (mean age 51) had repair of partial AV canal. Twenty-three patients had repair of the cleft mitral valve; two had mitral valve replacements; and six needed no mitral valve operation.
Results:
Early mortality was 6%. One patient was lost to follow-up. Nine of the early survivors are known to have died. There is a small but significant development over the long term of atrial arrhythmias, complete heart block, subaortic stenosis, recurrent mitral regurgitation and, rarely, mitral stenosis. Three of the 28 patients available for follow-up had mitral valve reoperation and subaortic stenosis developed in 2. Nineteen patients were alive in 1991 (mean follow-up 14 years). Seven patients were in New York Heart Association functional class I, eight were in class II, and four were in class III. Fifteen of the 19 patients reported sustained postoperative improvement.
Conclusions:
Patients > or = 40 years old can have partial AV canal repair with low risk. Long-term survival is good, with subjective improvement in symptoms. Late complications occur but are uncommon, suggesting that long-term follow-up is warranted.