Atrioventricular valve function after single patch repair of complete atrioventricular septal defect in infancy: How early should repair be attempted?

Abstract

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.

Contemporary outcomes of complete atrioventricular septal defect repair: Analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database

“…In contrast, Suzuki and colleagues 5 reported a higher incidence of preoperative left atrioventricular valve regurgitation in infants who underwent repair at age <3 months, but no difference in postoperative residual regurgitation or reoperation for left atrioventricular valve dysfunction. Similarly, Reddy and colleagues 20 reported on a series of 72 infants with repair at median age of 3.9 months (40%<3 months) and concluded that age at repair does not influence outcome or valve function. With the exception of the study by Atz and colleagues, 9 the above-mentioned reports all describe single institution experiences that reflect individual centers’ surgical technique and postoperative management.…”

Results of Left Atrioventricular Valve Reoperations Following Previous Repair of Atrioventricular Septal Defects

“…Indications for LAVV reintervention are not well defined but two clinical scenarios are generally seen 10,12 . Early severe postoperative LAVV regurgitation may lead to persistent low cardiac output state and ventilator dependency requiring untimely reoperation.…”

Repair of Complete Atrioventricular Septal Defects: Results with Maintenance of the Coronary Sinus on the Right Atrial Side

“…Early experience showed that the surgical procedure was complicated by postoperative left atrioventricular valve dysfunction, conduction disturbance, and postoperative pulmonary hypertensive crisis 6,7 . In several studies, pulmonary artery banding, as a palliative procedure in early infancy, is no longer recommended unless other associated abnormalities make primary repair a high‐risk operation 8,9 . Better understanding of the pathoanatomic features of this disease, careful timing of the surgery, advances in surgical technique, and improvements in the preoperative and postoperative management have reduced the postoperative morbidity and mortality 8 …”