Long-term outcome after early repair of complete atrioventricular septal defect in young infants

Commentary: Regionalization = Excellence

“…

As I read the manuscript submitted by Dr Ramgren and colleagues from Lund, Sweden, I noted that their review of infants with atrioventricular septal defect (AVSD) began in 1993. 1 Given my interest in the regionalization of care, I recognized that was exactly 1 year after Sweden centralized the care of children with congenital heart disease from 4 to 2 dedicated centers. 2 Suddenly this review became not simply another article on surgical techniques and results, but possibly an outcomes analysis of the regionalization strategy embarked upon in 1992.

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Association of atrial septal fenestration with outcomes after atrioventricular septal defect repair

“…Although lower compared with the recently reported 20-year survival of 95% in the 25-year experience of Ramgren and colleagues, survival was similar to 5-and 15-year rates of 92% to 93% and 91% to 92% recently reported by Fong and colleagues. 15,16 The key question surrounding an atrial fenestration's association with increased mortality risk was how much did it directly contribute to the increased mortality risk we identified? Was atrial fenestration directly causing the increased mortality risk, was it a surrogate of severe ventricular unbalance or complexity of surgical repair, or was there a defined "cause and effect"?…”

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

“…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.…”