Complete atrioventricular septal defect repair in Australia: Results over 25 years

Fong, Laura S.; Betts, Kim; Bell, Douglas; Konstantinov, Igor E.; Nicholson, Ian; Winlaw, David S.; Orr, Yishay; Hu, Thomas; Radford, Dorothy J.; Alphonso, Nelson; Andrews, David

doi:10.1016/j.jtcvs.2019.08.005

Cited by 43 publications

(24 citation statements)

References 31 publications

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“…In patients with balanced complete AVSD, the freedom from reoperation is approximately 25% at 20 years. 11,13 In patients with unbalanced AVSD, the results are even more disappointing with 40% requiring reoperation by 15 years. 1,4 Imai and colleagues 21 reported 28 patients with unbalanced AVSD and univentricular physiology who underwent concomitant AVV repair and Fontan procedure between 1985 and 1998.…”

Section: Results Of Atrioventricular Valve Surgery Traditional Repair Techniquesmentioning

confidence: 99%

“…Great progress has been made in repair of balanced complete atrioventricular septal defect (AVSD) in recent years, with operative mortality reported of 1% to 3% and 20-year survival of approximately 90%. [11][12][13][14][15] Conversely, little progress has been made in the surgical management of unbalanced AVSD. Early reports suggested that only onethird of patients could survive to Fontan, and only onehalf of these patients with Fontan circulation went on to be long-term survivors.…”

Section: Outcomes Of Univentricular Repair In Patients With Common Atrioventricular Valvementioning

confidence: 99%

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Atrioventricular valve surgery: Restoration of the fibrous skeleton of the heart

Buratto

Konstantinov

2021

The Journal of Thoracic and Cardiovascular Surgery

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Millions of years of relentless evolution have shaped the human heart into a durable and incredibly efficient pump. This high durability and efficiency are impossible without the normal fibrous skeleton of the heart. To achieve optimal results in our surgical work, we must emulate the work of nature as closely as possible. A perfect example of this would be surgery for the atrioventricular valve (AVV). Although the results of AVV repair have improved over time, AVV regurgitation remains a formidable challenge, particularly, in the univentricular circulation. [1][2][3][4][5][6][7] Although more than 20% of patients with univentricular circulation develop moderate or greater AVV regurgitation of mitral, tricuspid, or common AVV by 20 years, the rate of failure of common AVV in the univentricular circulation is greater than 50% by 20 years. 3 Furthermore, it is unequivocal that AVV regurgitation is associated with poorer survival in patients with univentricular circulation. 5 Achieving a durable repair of AVV, including that in common AVV, is often difficult in univentricular circulation, especially in patients with right ventricular dominance. 3 In this focused review, we summarize the recent literature on the outcomes of AVV surgery in patients with univentricular circulation with emphasis on the importance of restoring the fibrous skeleton of the heart.

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Section: Results Of Atrioventricular Valve Surgery Traditional Repair Techniquesmentioning

confidence: 99%

Section: Outcomes Of Univentricular Repair In Patients With Common Atrioventricular Valvementioning

confidence: 99%

Atrioventricular valve surgery: Restoration of the fibrous skeleton of the heart

Buratto

Konstantinov

2021

The Journal of Thoracic and Cardiovascular Surgery

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“…Left atrioventricular valve reoperation rate for the autologous pericardium group (8%) and for the cohort as a whole (6%) did not exceed the incidence reported in the literature (11.4%). 10 In our opinion, VSD closure with the pericardial patch should be considered as an entirely new category which shows promising results when compared with the use of the modified single-patch technique and double-patch technique with synthetic VSD patch. Interestingly, all reoperations except one were performed on patients operated (AVSD repair) before 2000, suggesting a possible learning effect.…”

Section: Commentmentioning

confidence: 96%

Long-Term Follow-Up of Pericardium for the Ventricular Component in Atrioventricular Septal Defect Repair

IJsselhof

Duchateau

Schouten

et al. 2020

World J Pediatr Congenit Heart Surg

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Background: Despite the improved outcome in complete atrioventricular septal defect (AVSD) repair, reoperations for left atrioventricular valve (LAVV) dysfunction are common. The aim of this study was to evaluate the effect of fresh untreated autologous pericardium for ventricular septal defect (VSD) closure on atrioventricular valve function and compare the results with the use of treated bovine pericardial patch material. Methods: Clinical and echocardiographic data were collected of patients with complete AVSD with their VSD closed with either untreated autologous pericardial or treated bovine pericardial patch material between January 1, 1996, and December 31, 2003. Evaluation closed in September 2019. Results: A total of 77 patients were analyzed (untreated autologous pericardial VSD patch: 59 [77%], treated bovine pericardial VSD patch: 18 [23%]). Median age at surgery was 3.6 (interquartile range [IQR]: 2.7-4.5) months, and median weight was 4.5 (IQR: 3.9-5.1) kg. Trisomy 21 was present in 70 (91%) patients. Median follow-up time was 17.5 (IQR: 12.6-19.8) years. Death <30 days occurred in two (3%) patients. Reinterventions occurred in eight patients (early [within 30 days] in two, early and late in one, and late in five), all in the autologous pericardium group. Log-rank tests showed no significant difference in mortality ( P = .892), LAVV reinterventions ( P = .228), or LAVV regurgitation ( P = .770). Conclusions: In AVSD, the VSD can safely be closed with either untreated autologous pericardium or xeno-pericardium. We found no difference in LAVV regurgitation or the need for reoperation between the two patches.

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“…24 A recent multicenter study of 819 children who underwent repair of complete AVSD between 1990 and 2015 demonstrated no difference in survival or freedom from LAVV reoperation or LVOTO in a propensity-score matched analysis of 223 pairs. 25 The optimal approach to children with AVSD who develop early heart failure has remained unclear, with some groups preferring an initial pulmonary artery band (PAB) and others proceeding to primary complete repair. A recent study compared outcomes of patients with AVSD who underwent PAB with those who underwent primary complete repair in the Congenital Heart Surgeons' Society Database between 2012 and 2018.…”

Section: Atrioventricular Septal Defect Surgerymentioning

confidence: 99%

Highlights in congenital cardiothoracic surgery: 2020–2021

Buratto¹,

Konstantinov²

2021

The Journal of Thoracic and Cardiovascular Surgery

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Advances in congenital cardiothoracic surgery continue at a rapid pace. This year, for the first time, the Editorial Board of the Journal provides focused summaries of the key articles published in the American Association for Thoracic Surgery (AATS) journals during the year preceding the annual AATS meeting. These series of focused summaries will be published at the time of the AATS meetings. This particular compendium features articles on 3 topics: aortic valve surgery, the arterial switch operation (ASO), and atrioventricular septal defect (AVSD) repair.

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Complete atrioventricular septal defect repair in Australia: Results over 25 years

Cited by 43 publications

References 31 publications

Atrioventricular valve surgery: Restoration of the fibrous skeleton of the heart

Atrioventricular valve surgery: Restoration of the fibrous skeleton of the heart

Long-Term Follow-Up of Pericardium for the Ventricular Component in Atrioventricular Septal Defect Repair

Highlights in congenital cardiothoracic surgery: 2020–2021

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