Surgical outcomes of the modified single-patch technique in complete atrioventricular septal defect

Abstract

We examined the usefulness of the modified single-patch technique for the surgical management of complete atrioventricular septal defect (AVSD). Sixty-one patients undergoing total correction for complete AVSD from January 1997 to December 2006 were classified to the modified single-patch technique group (18 patients) and the classical one-/two-patch technique group (43 patients). The surgical outcomes of the modified single-patch technique were compared with those of the classical-patch technique. Aortic cross-clamp time was shorter in the modified single-patch technique group (110.8+/-27.5 min vs. 134.4+/-42.5 min, P=0.03). During the follow-up period, two patients required reoperation for atrioventricular valve dysfunction in the modified single-patch technique group vs. three patients in the classical-patch technique group (P=0.63). One late death occurred in the modified single-patch technique and two late deaths in the classical-patch technique group (P=0.90). There was no significant difference in surgical outcomes between the two groups. And the modified single-patch technique has the advantage of relative simplicity and shorter ischemic time, and thus it is thought to be a feasible surgical option for the repair of complete AVSD.

Results for Surgical Correction of Complete Atrioventricular Septal Defect: Associations with Age, Surgical Era, and Technique

“…Although modified single‐patch repair technique was reported to have the advantage of relative simplicity and shorter ischemic time, several previous reports comparing the outcomes of different surgical techniques for the repair of CAVSD showed no differences in residual septal defects, degree of postoperative LAVVR, need for reoperation, or duration of postoperative intensive care unit and hospital stays 16‐18 . Similarly, both in our first group (Group I) and in the second group (Group II) there were no significant differences in regard to postoperative intensive care unit and hospital stays between patients operated on using different surgical techniques (Table 3).…”

“…In this group, the mean age at repair was 9.4 ± 5.0 months, whereas overall mortality and reoperation rate was 26.6% (12 patients) and 13.3% (six patients), respectively 5 . Ages at repair, mortality, and reoperation rates of this group were significantly high with respect to the current literature 16‐18 . However, after August 2006 (Group II) our patient selection criteria evolved clearly, and the mean age at repair decreased to 5.2 ± 3.1 months in six years.…”

“…Previously, some reports claimed that modified single‐patch technique was not applicable in all patients of CAVSD such as with various intracardiac anatomies including a huge size VSD, CAVSD with tetralogy of Fallot pathology, and AV valve anomalies 7,17,18 . Conversion of the modified single‐patch technique to the classical two‐patch technique due to severe left AV valve regurgitation was also reported in some patients 17 . However, in our previous institutional report comprising the patients of Group I of this study, no significant difference related to the late postoperative AV valve functions was reported despite the preoperative randomized patient selection 5 .…”

A review of the Nunn modified single patch technique for atrioventricular septal defect repair

“…Overall, the outcomes in both groups were similar; however, the Nunn technique was simpler with shorter ischemic times. Despite this, the authors expressed concern that this technique may not be applicable for those with large VSD and associated TOF or valve abnormalities (27).…”

Preliminary results of direct closure of an atrioventricular septal defect: revisiting the original technique

“…Besides simplifying the surgery, it was demonstrated that eliminating the VSD patch has the advantage of better coaptation of the left AV valve by lowering the implantation level of the valve to the crest of the interventricular septum. [2,3,6] We were able to practice this method with success even in our older patient group who had a large VSD and thickened valves, and none of our patients had more than mild residual AV valve regurgitation after repair. In addition, this method is easier to perform on low-weight patients due to their flexible tissues, as we experienced in four patients weighting less than five kilograms.…”