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Modified Single-Patch Technique Versus Two-Patch Technique for the Repair of Complete Atrioventricular Septal Defect: A Meta-Analysis

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Abstract

Technical selection for surgical repair of complete atrioventricular septal defect (CAVSD) still remains controversial. This meta-analysis aimed to compare the modified single-patch (MP) technique with the two-patch (TP) technique for patients with CAVSD. Relevant studies comparing the MP technique with the TP technique were identified through a literature search using MEDLINE, EMBASE, Google Scholar, Cochrane Library, and the China National Knowledge Infrastructure databases. The variables were ventricular septal defect (VSD) size, cardiopulmonary bypass (CBP) time, aortic cross-clamp (ACC) time, intensive care unit stay, hospital stay, and other outcomes involving mortality, left ventricular outflow tract obstruction, atrioventricular valve regurgitation, residual septal shunt, atrioventricular block, and reoperation. A random-effect/fixed-effect model was used to summarize the estimates of mean difference/odds ratio with 95% confidence interval. Subgroup analysis stratified by region was performed. Fifteen publications involving 1034 patients were included. This meta-analysis demonstrated that (1) VSD size in the MP group was significantly smaller; (2) CBP time, ACC time, and hospital stay in the MP group experienced improvement; (3) Other postoperative outcomes showed no significant differences between two groups; and (4) The trends in China and other countries were close. The MP and TP techniques had comparable outcomes; however, the MP technique was performed with significantly shorter CBP and ACC times in patients with smaller VSDs. Given this limitation of data, the results of comparison of the two techniques in patients with larger VSDs remain unknown. Further studies are needed.

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References

  1. Litwin SB, Tweddell JS, Mitchell ME et al (2007) The double patch repair for complete atrioventricularis communis. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 10:21–27

    Article  Google Scholar 

  2. Lillehei CW, Cohen M, Warden HE et al (1955) The direct vision intracardiac correction of congenital anomalies by controlled cross circulation. Surgery 38:11–29

    CAS  PubMed  Google Scholar 

  3. Jonas RA (2014) Complete atrioventricular canal. In: Comprehensive surgical management of congenital heart disease, 2nd edn. Taylor & Francis Group, Boca Raton, pp 517–533

  4. Maloney JV Jr, Marable SA, Mulder DG (1962) The surgical treatment of common atrioventricular canal. J Thorac Cardiovasc Surg 43:84–96

    PubMed  Google Scholar 

  5. Rastelli GC, Ongley PA, Kirklin JW et al (1968) Surgical repair of the complete form of persistent common atrioventricular canal. J Thorac Cardiovasc Surg 55:299–308

    CAS  PubMed  Google Scholar 

  6. Trusler GA (1976) Discussion of: Mills NL, Ochsner JL, King TD. Correction of type C complete atrioventricular canal: surgical considerations. J Thorac Cardiovasc Surg 71:20–28

    Google Scholar 

  7. Wilcox BR, Jones DR, Frantz EG et al (1997) Anatomically sound, simplified approach to repair of ‘‘complete’’ atrioventricular septal defect. Ann Thorac Surg 64:487–494

    Article  CAS  PubMed  Google Scholar 

  8. Nicholson IA, Nunn GR, Sholler GF (1999) Simplified single patch technique for the repair of atrioventricular septal defect. J Thorac Cardiovasc Surg 118:642–646

    Article  CAS  PubMed  Google Scholar 

  9. Deraz S, Ismail M (2014) Single patch technique versus double patch technique in repair of complete atrioventricular septal defect. Egypt Heart J 66:177–182

    Article  Google Scholar 

  10. Backer CL, Stewart RD, Mavroudis C (2007) What is the best technique for repair of complete atrioventricular canal? Semin Thorac Cardiovasc Surg 19:249–257

    Article  PubMed  Google Scholar 

  11. Jonas RA, Mora B (2010) Individualized approach to repair of complete atrioventricular canal: selective use of the traditional single-patch technique versus the Australian technique. World J Pediatr Congenit Heart Surg 1:78–86

    Article  PubMed  Google Scholar 

  12. Crawford FA (2007) Atrioventricular canal: single-patch technique. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 10:11–20

    Article  Google Scholar 

  13. Shamseer L, Moher D, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 349:g7647

    Article  PubMed  Google Scholar 

  14. Howick J (2009) Oxford Centre for evidence-based medicine: levels of evidence. centre for evidence based medicine. http://www.cebm.net/index.aspx?o=1025. Accessed 16 Nov 2016

  15. Rastelli GC, Kirklin JW, Titus JL (1966) Anatomic observations on complete form of persistent common atrioventricular canal with special reference to atrioventricular valves. Mayo Clin Proc 41:296–308

    CAS  PubMed  Google Scholar 

  16. Ugaki S, Khoo NS, Ross DB et al (2014) Modified single-patch compared with two-patch repair of complete atrioventricular septal defect. Ann Thorac Surg 97:666–6671

    Article  PubMed  Google Scholar 

  17. Higgins JP, Thompson SG, Deeks JJ et al (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  18. DerSimonian R, Kacker R (2007) Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials 28:105–114

    Article  PubMed  Google Scholar 

  19. Jia B, Ye M, Chen ZG et al (2013) Surgical treatment of complete atrioventricular septal defect. J Cardiovasc Pulm Dis 32:692–694

    Google Scholar 

  20. Liu YL, Wu YT, Xu YQ et al (2013) Clinical experience for surgical treatment of total endocardial cushion defect. J Cardiovasc Pulm Dis 32:671–674

    Google Scholar 

  21. Pan G, Song L, Zhou X et al (2014) Complete atrioventricular septal defect: comparison of modified single-patch technique with two-patch technique in infants. J Card Surg 29:251–255

    Article  PubMed  Google Scholar 

  22. Qiu LS, Zheng H, Liu JF et al (2007) Surgical repair of complete atrioventricular septal defect. Chin J Thorac Cardiovasc Surg 23:369–371

    Google Scholar 

  23. Shi G, Chen H, Hong H et al (2015) Results of one-and-a-half-patch technique for repair of complete atrioventricular septal defect with a large ventricular component. Eur J Cardiothorac Surg 47:520–524

    Article  PubMed  Google Scholar 

  24. Yuan F, Li XF, Guo J et al (2013) Comparison of modified single-patch technique with two-patch technique in infant with complete atrioventricular septal defect. Chin J Thorac Cardiovasc Surg 29:279–281

    CAS  Google Scholar 

  25. Zhu ZQ, Su ZH, Xu ZW et al (2004) Comparison of three surgical techniques in the repair of complete atrioventricular septal defect. Chin J Surg 42:634–635

    Google Scholar 

  26. Al Senaidi KS, Ross DB, Rebeyka IM et al (2014) Comparison of two surgical techniques for complete atrioventricular septal defect repair using two- and three-dimensional echocardiography. Pediatr Cardiol 35:393–398

    Article  PubMed  Google Scholar 

  27. Atz AM, Hawkins JA, Lu M et al (2011) Surgical management of complete atrioventricular septal defect: associations with surgical technique, age, and trisomy 21. J Thorac Cardiovasc Surg. 141:1371–1379

    Article  PubMed  Google Scholar 

  28. Backer CL, Stewart RD, Bailliard F et al (2007) Complete atrioventricular canal: comparison of modified single-patch technique with two-patch technique. Ann Thorac Surg 84:2038–2046 (Discussion 2038-2046)

    Article  PubMed  Google Scholar 

  29. Harmandar B, Aydemir NA, Karaci AR et al (2012) Results for surgical correction of complete atrioventricular septal defect: associations with age, surgical era, and technique. J Card Surg 27:745–753

    Article  PubMed  Google Scholar 

  30. Nunn GR (2007) Atrioventricular canal: modified single patch technique. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 10:28–31

    Article  Google Scholar 

  31. Sivalingam S, Krishnasamy S, Al-Fahmi NA et al (2013) Early and midterm outcome of complete atrioventricular septal defect (AVSD) in a single institution. Indian J Thorac Cardiovasc Surg 29:223–229

    Article  Google Scholar 

  32. Yildirim O, Avsar M, Ozyuksel A et al (2015) Modified single versus double-patch technique for the repair of complete atrioventricular septal defect. J Card Surg 30:595–600

    Article  PubMed  Google Scholar 

  33. Halit V, Oktar GL, Imren VY et al (2008) Traditional single patch versus the “Australian” technique for repair of complete atrioventricular canal defects. Surg Today 38:999–1003

    Article  PubMed  Google Scholar 

  34. Kumar DA, Kumar RNS, Rao PN et al (2003) Complete atrioventricular septal defect repair: Simplified single patch technique. Indian J Thorac Cardiovasc Surg 19:102–107

    Article  Google Scholar 

  35. Jeong IS, Lee CH, Lee C et al (2009) Surgical outcomes of the modified single-patch technique in complete atrioventricular septal defect. Interact Cardiovasc Thorac Surg 8:435–437 (Discussion 437-438)

    Article  PubMed  Google Scholar 

  36. Crawford FA Jr, Stroud MR (2001) Surgical repair of complete atrioventricular septal defect. Ann Thorac Surg 72:1621–1628 (Discussion 1628-1629)

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Dongxu Li was supported by grants from the China Scholarship Council.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People’s Republic of China

    Dongxu Li, Qiang Fan & Qi An

  2. Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, Japan

    Dongxu Li, Tomoyuki Iwase & Yasutaka Hirata

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  1. Dongxu Li
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  3. Tomoyuki Iwase
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  4. Yasutaka Hirata
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Correspondence to Qi An.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Supplementary material 1 (TIFF 609 kb) Fig. e6 Forest plots and subgroup analysis for MD of ICU stay in CAVSD patients with MP technique versus TP technique

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Supplementary material 2 (TIFF 1558 kb) Fig. e7 Forest plots and subgroup analysis for ORs of early mortality (a) and overall mortality (b) in CAVSD patients with MP technique versus TP technique

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Supplementary material 3 (TIFF 1430 kb) Fig. e8 Forest plots and subgroup analysis for ORs of LVOTO (a) and residual septal defects (b) in CAVSD patients with MP technique versus TP technique

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Supplementary material 4 (TIFF 1506 kb) Fig. e9 Forest plots and subgroup analysis for ORs of complete AVB (a) and overall reoperation (b) in CAVSD patients with MP technique versus TP technique

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Supplementary material 5 (TIFF 2317 kb) Fig. e10 Forest plots and subgroup analysis for MDs of the grades of LAVV regurgitation (a) and RAVV regurgitation (b) in CAVSD patients with MP technique versus TP technique

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Li, D., Fan, Q., Iwase, T. et al. Modified Single-Patch Technique Versus Two-Patch Technique for the Repair of Complete Atrioventricular Septal Defect: A Meta-Analysis. Pediatr Cardiol 38, 1456–1464 (2017). https://doi.org/10.1007/s00246-017-1684-8

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  • DOI: https://doi.org/10.1007/s00246-017-1684-8

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