Abstract
Background
Surgical repair of complete atrioventricular septal defect is a well established procedure performed in young children. We sought to determine the rate of survival, reoperation and occurrence of Left Atrioventricular Valve Regurgitation (LAVVR).
Patients and methods
This was a retrospective review of 56 patients with Complete Atrioventricular Septal Defect (CAVSD) recruited from January 2000 till July 2010. Sixty-six percent of these patients had Down’s Syndrome. The median age and weight at surgery was 0.95 ± 2.7 years and 6.2 ± 7.5 kg respectively. 2D Echocardiography was used to quantify the degree of LAVVR pre and postoperatively. The technique of repair used was either 2 patch, modified single patch or single patch. The cleft in the LAVV was closed in all cases. Risk factors associated with increased mortality and re-intervention were analyzed.
Results
The operative mortality was 5.4 %. There were 3 patients who developed complete heart block and required Permanent Pace Maker (PPM) implantation whereas 11 patients (20 %) developed supraventricular arrhythmia. Twenty-one percent of patients had moderate LAVVR at discharge. Eight patients (14 %) required re-operation for LAVV regurgitation at a mean duration of 17 ± 29 months. The mean ICU stay was 6 days. Prolonged ventilation and presence of infection trended towards higher mortality. The presence of moderate or severe LAVVR at discharge was one of the main factors for re-intervention.
Conclusion
The surgical repair of Complete Atrioventricular Septal Defect in young children is associated with acceptable mortality and morbidity. Left atrio-ventricular valve regurgitation remains the most common residual defect and significantly associated with re-intervention.
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References
Backer CL, Mavroudis C. Atrioventricular canal defects. In: Mavroudis C, Backer CL, editors. Pediatric cardiac surgery. 3rd ed. Philadelphia: Mosby; 2003. p. 321–38.
Reddy VM, McElhinney DB, Brook MM, Parry AJ, Hanley FL. Atrioventricular valve function after single patch repair of complete atrioventricular septal defect in infancy: how early should repair be attempted? J Thorac Cardiovasc Surg. 1998;115:1032–40.
Singh RR, Warren PS, Reece TB, et al. Early repair of complete atrio ventricular septal defect is sand effective. Ann Thorac. 2006;82:1598–601.
Backer CL, Mavroudis C, Alboliras ET, Zales VR. Repair of complete atrioventricular canal defects : results with the two patch technique. Ann Thorac Surg. 1995;60:530–7.
Alexi-Meskishvili V, Ishino K, Dahnert I, et al. Correction of complete atrio-ventricular septal defects with the double-patch technique and cleft closure. Ann Thorac Surg. 1996;62:519–25.
Kumar DA, Suresh Kumar RN, Rao PN, et al. Complete atrioventricular septal defect repair: simplified single patch technique. Indian J Thorac Cardiovasc Surg. 2003;19:102–7.
Bakhtiary F, Takacs J, Cho MY, et al. Long-term results after repair of complete atrioventricular septal defect with two-patch technique. Ann Thorac Surg. 2010;89:1239–43.
Suzuki T, Bove EL, Devaney EJ, et al. Results of definitive repair of complete atrioventricular septal defect in neonates and infants. Ann Thorac Surg. 2008;86:596–602.
Chowdhury UK, Airan B, Malhotra A, et al. Specific issues after surgical repair of partial atrioventricular septal defect: actuarial survival, freedom from reoperation, fate of the left atrioventricular valve, prevalence of left ventricular outflow tract obstruction, and other events. J Thorac Cardiovasc Surg. 2009;137:548–55.
Crawford FA, Stroud MR. Surgical repair of complete atrioventricular septal defect. Ann Thorac Surg. 2001;72:1621–9.
Bando K, Turrentine MW, Sun K, et al. Surgical management of complete atrioventricular septal defects in infants. A twenty year experience. J Thorac Cardiovasc Surg. 1995;110:1543–54.
Michielon G, Stellin G, Rizzoli G, Casarotto DC. Repair of complete common atrioventricular canal defects in patients younger than four months of age. Circulation. 1997;96:II-316–22.
Tweddell JS, Litwin SB, Berger S, et al. Twenty-year experience with repair of complete atrioventricular septal defects. Ann Thorac Surg. 1996;62:419–24.
Najm HK, Coles JG, Endo M, et al. Complete atrioventricular septal defects. Results of repair, risk factors, and freedom from reoperation. Circulation. 1997;96:II311–5.
Prifti E, Bonacchi M, Bernabei M, et al. Repair of complete atrioventricular septal defects in patients weighing less than 5 kg. Ann Thorac Surg. 2004;77:1717–26.
Wetter J, Sinzobahamvya N, Blascchczok C, et al. Closure of the zone of apposition at correction of complete atriventricular septal defect improves outcome. Eur J Cardiothorac Surg. 2000;17:146–53.
Dodge-Khatami A, Herger S, Rousson V, et al. Outcomes and reoperations after total correction of complete atrioventricular septal defect. Eur J Cardiothorac Surg. 2008;34:745–50.
Günther T, Mazzitelli D, Haehnel CJ, Holper K, Sebening F, Meisner H. Long-term results after repair of complete atrioventricular septal defects: analysis of risk factors. Ann Thorac Surg. 1998;65:754–9.
Hanley FL, Fenton KN, Jonas RA, et al. Surgical repair of complete atrioventricular canal defects in infancy. J Thorac Cardiovasc Surg. 1993;106:387–97.
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Sivalingam, S., Krishnasamy, S., Afeena Al-Fahmi, N. et al. Early and midterm outcome of complete Atrioventricular Septal Defect (AVSD) in a single institution. Indian J Thorac Cardiovasc Surg 29, 223–229 (2013). https://doi.org/10.1007/s12055-013-0256-7
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DOI: https://doi.org/10.1007/s12055-013-0256-7