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Atrioventricular valve function after single patch repair of complete atrioventricular septal defect in infancy: how
V M Reddy1, D B McElhinney, M M Brook
1Division of Cardiothoracic Surgery, University of California, San Francisco, USA.
Insights
Surgical repair of complete atrioventricular septal defects in infants yields excellent outcomes, even in neonates. Meticulous surgical techniques ensure favorable results, regardless of patient age at the time of repair.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Pediatric Cardiac Surgery
Background:
- Complete atrioventricular septal defects (CAVSD) are common congenital heart conditions.
- Surgical repair of CAVSD in infancy is routine, but concerns exist regarding atrioventricular valve tissue fragility in very young infants.
- Medical management is sometimes preferred for neonates due to perceived risks associated with valve tissue fragility.
Purpose of the Study:
- To evaluate the safety and efficacy of primary surgical repair for complete atrioventricular septal defects in infants, including very young infants.
- To assess the impact of age at repair on postoperative outcomes and atrioventricular valve function.
- To determine the long-term results of a single-patch technique for CAVSD repair.
Main Methods:
- Seventy-two infants underwent primary repair of CAVSD using a single-patch technique between July 1992 and a median age of 3.9 months.
- Complete cleft closure was performed in most patients, with partial or no closure in select cases at risk for valve stenosis.
- Left atrioventricular valve annuloplasty was performed in 18 patients, and transesophageal echocardiography guided intraoperative revisions.
Main Results:
- One early death occurred in a patient with single left papillary muscle; no early reoperations or new permanent arrhythmias were noted.
- Postoperative moderate left atrioventricular valve regurgitation was observed in only three patients at discharge.
- During a median 24-month follow-up, one late death and five reoperations (for regurgitation or outflow obstruction) occurred. Age at repair did not correlate with adverse outcomes or valve function.
Conclusions:
- Meticulous surgical techniques enable excellent outcomes in the repair of complete atrioventricular septal defects, even in very young infants.
- Concerns regarding atrioventricular valve tissue fragility should not preclude surgical intervention in neonates and infants.
- Age at repair does not significantly influence the long-term outcomes or valve function following CAVSD repair.
Background:
Though repair of complete atrioventricular septal defect in infancy has become routine at most centers, it is not unusual for very young infants to be managed medically because of concerns about the fragility of the atrioventricular valve tissue.
Methods:
Since July 1992, seventy-two infants have undergone primary repair of complete atrioventricular septal defects at a median age of 3.9 months (40% < 3 months). A single-patch technique was used in all patients. The cleft was closed completely in 61 patients and partially (n = 10) or not at all (n = 1) in select patients at risk for valve stenosis. Left atrioventricular valve annuloplasty was performed in 18 patients. On the basis of transesophageal echocardiographic findings, 10 patients were returned to bypass for revision of the valve repair.
Results:
There was one early death in a patient with single left papillary muscle, no early reoperations, and no new permanent arrhythmias. Only three patients had moderate left atrioventricular valve regurgitation at discharge. During a median follow-up of 24 months, there was one late death and five reoperations for left atrioventricular valve regurgitation (n = 2) and/or systemic outflow obstruction (n = 4). Follow-up left atrioventricular valve regurgitation was moderate in three patients, mild in 14, and none/trace in 54. Age had no relation to postoperative atrioventricular valve regurgitation, death, or reoperation.
Conclusions:
Despite concerns about fragility of valve tissue in very young patients, excellent results can be achieved with meticulous techniques. From neonates to older infants, age at repair does not influence outcome or valve function.