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Complete atrioventricular septal defects: results of repair, risk factors, and freedom from reoperation
1Division of Cardiovascular Surgery, The Hospital for Sick Children and the University of Toronto Faculty of Medicine, Ontario, Canada.
Insights
Repair of complete atrioventricular septal defects in children shows acceptable mortality and low reoperation rates. Key predictors of survival include patient age, ischemic time, and left atrioventricular valve cleft closure.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiac Surgery Outcomes
Background:
- Complete atrioventricular septal defects (CAVSD) are complex congenital heart conditions.
- Identifying perioperative risk factors is crucial for improving surgical outcomes in pediatric CAVSD repair.
Purpose of the Study:
- To investigate the association between perioperative risk factors and outcomes after CAVSD repair.
- To determine the impact of these factors on perioperative mortality and the need for reoperation.
Main Methods:
- Retrospective analysis of 363 children undergoing CAVSD repair between July 1982 and February 1995.
- Evaluation of surgical techniques, patient demographics, associated anomalies, and long-term outcomes including survival and reoperation rates.
Main Results:
- Early mortality was 10.5% with a 10-year survival rate of 83%.
- Freedom from reoperation at 10 years was high for various complications, including LAVV repair (86%) and subaortic stenosis (95%).
- Greater age at operation, shorter ischemic time, absence of a double-orifice LAVV, and complete cleft closure were significant independent predictors of survival.
Conclusions:
- Surgical repair of CAVSD offers acceptable early and late mortality with a low incidence of reoperation.
- A double-orifice left atrioventricular valve (LAVV) is identified as a significant risk factor.
- Complete closure of the LAVV cleft during repair may be associated with improved survival rates.
Background:
Several perioperative risk factors influence outcomes after repair of complete atrioventricular septal defects. This study was conducted to determine their association with perioperative mortality and need for reoperation.
Method And Results:
Between July 1982 and February 1995, 363 children underwent defect repair (median age, 8.3 months; mean, 17.4+/-1.3). Tetralogy of Fallot was present in 21 patients, double-outlet right ventricle in 4, subaortic stenosis in 8, ventricular hypoplasia in 8, coarctation in 5, atrial isomerism in 2, and other congenital anomalies in 9. Down's syndrome was present in 235 (65%). One-patch technique was applied in 99, two-patch in 243. During repair, the anterior bridging leaflet was divided in 12, the posterior bridging leaflet in 31, both leaflets in 71, and neither in 249. Left atrioventricular valve (LAVV) cleft was closed partially in 181 and completely in 112. Early mortality was 10.5%; 10-year survival, 83% (95% confidence interval, 0.79 to 0.87). At 10 years, freedom from reoperation for LAVV repair was 86%; LAVV replacement, 90%; subaortic stenosis, 95%; residual ventricular septal defect, 97%; permanent pacemaker insertion, 98%; and other types of reoperation, 95%. At the time of operation, greater age, shorter ischemic time, absence of a double-orifice LAVV, and cleft closure were found to be significant independent predictors of survival.
Conclusions:
Repair of atrioventricular septal defects has acceptable early and late mortality and a low incidence of reoperation. Double-orifice LAVV remains a risk factor. Repairs that include complete cleft closure may confer better survival.