Outcomes of repair of complete atrioventricular septal defect in the current era

• Published in: European journal of cardio-thoracic surgery Vol. 45; no. 4; pp. 610 - 617
• Main Authors: Xie, Ouli, Brizard, Christian P., d'Udekem, Yves, Galati, John C., Kelly, Andrew, Yong, Matthew S., Weintraub, Robert G., Konstantinov, Igor E.
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 01-04-2014
• Subjects: Child, Preschool; Female; Heart Septal Defects; Humans; Infant; Male; Mitral Valve Insufficiency - surgery; Postoperative Complications; Risk Factors; Treatment Outcome; Surgery; Atrioventricular septal defect; Outcomes
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezt444

OBJECTIVES
We sought to evaluate the surgical outcomes of the repair of complete atrioventricular septal defects (cAVSDs) in our institution in the current era.
METHODS
From 2000 to 2011, 138 patients underwent definitive repair of cAVSD. Repair was performed using a two-patch technique in 92.0% of patients and one-patch technique in 2.2%, and the ventricular septal component was closed directly in 5.8% of patients.
RESULTS
Operative mortality was 1.4% (2 of 138). Overall mortality was 5.8% (8 of 138). Follow-up was 96% complete. Freedom from reoperation was 84.3% (95% CI 77.1-91.5%) at 8 years. Age >6 months at repair was associated with higher rates of reoperation (P = 0.001; HR 6.85; 95% CI 2.30-20.44). However, operating at <6 months of age was associated with longer intensive care unit stay (P = 0.019; median 2.7 vs 1.4 days), mechanical ventilation (P = 0.001; median 1.7 vs 0.9 days) and postoperative hospital stay (P = 0.016; median 8 vs 5 days). Moderate or greater left atrioventricular valvular regurgitation (LAVVR) at discharge was a risk factor for reoperation (P < 0.001; HR 10.85; 95% CI 3.75-31.40).
CONCLUSIONS
Repair of cAVSD carries low mortality, but a moderate reoperation rate. An optimal time for repair of the cAVSD is between 3 and 6 months of age. Repair prior to 3 months of age and the need for cleft closure were associated with a higher degree of LAVVR at discharge. Greater LAVVR at discharge is a risk factor for reoperation regardless of age at initial repair. In the current era, Down's syndrome is not a risk factor for reoperation.