Surgical management of complete atrioventricular septal defect: Associations with surgical technique, age, and trisomy 21

Abstract

Objectives We sought to evaluate contemporary results after repair of a complete atrioventricular septal defect (AVSD) and to determine factors associated with suboptimal outcomes. Methods Demographic, procedural, and outcome data were obtained within 1 and 6 months after repair of complete AVSD in 120 children in a multicenter observational study from 6/04-2/06. Results Median age at surgery was 3.7 months (range, 9 days-1.1 years). Type of surgical repair was single patch (18%), double patch (72%), and single atrial septal defect patch with primary ventricular septal defect closure (10%). Residual septal defects and degree of left atrioventricular valve regurgitation (LAVVR) did not differ by repair type. Median days of intensive care stay were 4, ventilation 2, and total hospitalization 8; all were independent of the presence of Trisomy 21 (80% of cohort). Hospital mortality was 3/120 (2.5%); overall 6 month mortality was 5/120 (4%). The presence of associated anomalies and younger age at surgery were independently associated with longer hospital stay. Age at repair was not associated with residual VSD or ≥moderate LAVVR at 6 months. Moderate or greater LAVVR occurred in 22% at 6 months; the strongest predictor for this was moderate or greater LAVVR at 1 month, (odds ratio 6.9, 95% CI 2.2, 21.7), P<0.001. Conclusions Outcomes following repair of complete AVSD did not differ by repair type or presence of Trisomy 21. Earlier age at surgery was associated with increased resource utilization but had no association with incidence of residual VSD or significant LAVVR.

Long-term outcomes after surgical repair of complete atrioventricular septal defect

“…18,19 However, a more recent multicenter cohort of patients with CAVSD did not demonstrate a higher risk for residual ventricular septal defect in patients repaired with the classic 1-patch versus the 2-patch technique. 20 In addition, the classic 1-patch technique involves dividing the common valve leaflets and suspending them from a single patch; it may result in more distortion of the valve tissue, with a higher risk for reoperation for left AV valve regurgitation. 4 However, patch technique was not found to be a significant risk factor for this complication in our series.…”

Association Between Down Syndrome and In-Hospital Death Among Children Undergoing Surgery for Congenital Heart Disease

“…1,2,[11][12][13]19,22,23,30 In a study using the 2000 version of the KID to examine the role of sex as a risk factor for in-hospital mortality after pediatric cardiac surgery, DS was 1 of 4 comorbidities used as at CONS CALIFORNIA DIG LIB on January 21, 2016 http://circoutcomes.ahajournals.org/ Downloaded from independent, nonprocedural variables. The findings of this study are consistent with our findings and demonstrate lower odds of in-hospital mortality for patients with DS.…”

“…[14][15][16] The vast majority of infants born with an AVSD also have DS [11][12][13][17][18][19][20][21] ; however, DS is not a known risk factor for morbidity and mortality after biventricular AVSD repair. 12,22 In fact, infants with DS tend to have better outcomes after surgical repair of an AVSD compared with infants without DS. [11][12][13]23 Surprisingly, little is known about the outcomes of children with DS after surgical correction of congenital cardiac defects other than an AVSD.…”

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

“…A recent study by Atz and the Pediatric Heart Network (PHN) Investigators 9 reported outcomes of 120 patients who underwent repair of CAVSD at 7 centers. Adverse outcomes were negatively correlated with age at repair from birth to age 2.5 months, but did not vary by age beyond 2.5 months.…”

“…Apart from the PHN study, 9 there are no recent large multicenter studies pertaining to surgical outcomes among infants with CAVSD. The aim of our study is to provide a descriptive analysis of contemporary multicenter experience with repair of CAVSD using data from the STS-CHSD.…”