Surgery of the Complete Atrioventricular Canal: Relationship between Age at Operation, Mitral Regurgitation, Size of the Ventricular Septum Defect, Additional Malformations and Early Postoperative Outcome

Abstract

The perioperative risk after repair of the complete atrioventricular canal is reported to be low provided there is a balanced relationship of both ventricles, and elevated pulmonary vascular resistance has been demonstrated to be reversible. However, some pre- and perioperative conditions may adversely affect early postoperative outcome. A consecutive series of 42 patients (mean age 8.5 months, 34/42, 81%, with trisomy 21) operated between 1994 and 1998 was analyzed prospectively for pre- and perioperative risk factors. Echocardiography alone was performed in 35 patients whereas cardiac catheterization was performed in 7 patients aged more than 18 months to confirm operability. Additional malformations were found in 20 patients. Early mortality was 2.3% (1/42), and postoperatively a low cardiac output was observed in 25 patients (59%); NO inhalation was used in 12 patients. Only the size of the ventricular septal defect (> than the diameter of the aortic annulus) could be identified as a predictor of adverse postoperative outcome in multivariate analysis. The presence of associated intracardiac malformations showed a trend to increased perioperative risk in multivariate analysis. Early results after repair of the complete atrioventricular canal are excellent. Survival, postoperative morbidity and normalization of pulmonary artery pressure can be related to the size of the ventricular septal defect. Continuous monitoring of the pulmonary artery pressure (with consequent NO application when indicated) is probably responsible for the low perioperative risk encountered in this series, despite the high incidence of postoperative pulmonary artery hypertension.

Female gender increases the risk of death during hospitalization for pediatric cardiac surgery

“…Congenital Heart Surgeons Society have not demonstrated gender differences in surgical outcome for a variety of operations to correct specific kinds of congenital heart disease, including transposition of the great arteries, 9,10 atrioventricular septal defects and atrioventricular canal, 11,12 hypoplastic left heart syndrome and other forms of singleventricle physiology, [13][14][15][16] aortic stenosis or atresia, 17,18 and aortic arch interruption. 19 However, these studies were subject to a variety of limitations, including potential selection biases, relatively small sample sizes, and limited ability to adjust for potential gender-procedure interactions.…”

Motor development in children with congenital cardiac diseases compared to their healthy peers

“…For some complex malformations with functionally univentricular physiology, only palliative solutions are available. Lesions such as tetralogy of Fallot, 30 atrio-ventricular septal defect 31 and transposition 32 can now successfully be corrected in infancy with good long-term outcomes. After such successful correction in infancy, most of the children borne with cyanotic congenital cardiac malformations are able to participate in all physical activities appropriate to their age along with their healthy peers.…”

Care Models and Associated Outcomes in Congenital Heart Surgery

“…In addition, it may be that a multidisciplinary specialized care team associated with an CICU fosters earlier recognition and management of postoperative complications, such as pulmonary hypertension in patients undergoing complete atrioventricular canal repair. 37,38 Studies in the adult cardiac population have suggested that lower mortality rates in highperforming centers are due to significantly lower mortality associated with postoperative complications. 39 Finally, in evaluating the impact of the shift toward care in dedicated CICUs, other factors beyond the scope of this study may require consideration.…”