Long-term results after repair of complete atrioventricular septal defects: analysis of risk factors

We analyzed data from 320 patients to evaluate the impact of different preoperative, operative, and postoperative factors on the outcome after repair of complete atrioventricular septal defect.

Between October 1974 and December 1995, 320 patients with complete atrioventricular septal defect not associated with major cardiac anomalies were operated on. Two hundred seventy-four patients underwent total repair. Sixty-three patients (23%) were less than 6 months old. One hundred ninety-eight (72.2%) underwent primary repair. Seventy-six patients (27.7%) had a previous palliative operation.

Operative mortality in patients who underwent primary repair decreased from 17.6% (1974 to 1979) to 5.0% (1990 to 1995) despite an increase in the number of patients younger than 6 months. In patients undergoing a two-stage procedure operative mortality was 3.9% (late mortality, 7.9%). Young age (<6 months) was an incremental risk factor (p = 0.008) for operative mortality in the early study period. Coarctation of the aorta (p = 0.02) and severe dysplastic left atrioventricular valve (p = 0.001) were associated with a higher risk for operative mortality. Freedom from reoperation at 10 years was 82.5% +/- 3.8%.

In patients with complete atrioventricular septal defect, primary repair is the treatment of choice and can be accomplished with good results. In our experience over a period of more than 20 years, earlier date of operation, young age (<6 months), dysplastic left atrioventricular valve, and coexisting coarctation were incremental risk factors for hospital death. The presence of a previously placed pulmonary artery band did not alter the outcome of repair. The reconstructed atrioventricular valve shows a good and long-lasting performance.