The effect of surgical technique, age, and Trisomy 21 on early outcome of surgical management of complete atrioventricular canal defect

Abstract

Background: The optimal timing, surgical technique, and the influence of Trisomy 21 on the outcome of surgical repair of Complete Atrioventricular Canal Defect remains uncertain. We reviewed our experience in the repair of CAVC to identify the influence of these factors on operative outcomes. Methods: A prospective study included 70 patients, who underwent repair of CAVC at our institute between July, 2016 and October, 2019. Primary endpoint was mortality and the secondary endpoint was a degree of left atrioventricular valve regurgitation. Results: No significant difference was noted between patients operated on, at the first 6 months of age versus later, regarding mortality or LAVV regurgitation. Surgical repair by modified single-patch technique showed a significant reduction in bypass time (71.13 ± 13.507 min versus 99.19 ± 27.092 min, p-value = 0.001). Compared to closure of cleft only, posterior annuloplasty used for repair of LAVV resulted in significant reduction in the occurrence of post-operative valve regurgitation during the early period (LAVV 2 + 43 versus 7 %, p-value = 0.03) and at 6 months of follow-up (LAVV 2 + 35.4 versus 0 %, p-value = 0.01), respectively. Conclusions: Early intervention, in the first 6 months in patients with CAVC by surgical repair gives comparable acceptable results to later repair; Trisomy 21 was not found to be a risk factor for early intervention. Repair of common AV valve by cleft closure with posterior LAVV annuloplasty showed better results with a significant decrease in post-operative LAVV regurgitation and early mortality in comparison to the closure of cleft only.

Outcomes after repair of complete atrioventricular canal with a modified single-patch technique: a retrospective study

“…The modified single-patch repair technique for CAVC is a well-established technique [5][6][7][8]9]. However, division of the bridging leaflets is often required, and this process may cause some issues during the long-term follow-up of these patients.…”

Timing of surgical repair and resource utilisation in infants with complete atrioventricular septal defect

“…These findings are generally consistent with the previous studies that concluded that surgical intervention in this population can be done safely and effectively at a relatively early age, albeit with some increased length of ICU and hospital stay. 6,7,11,[14][15][16] The lack of important differences in clinical outcomes and resource utilisation outcomes noted in this study was likely influenced by judgement utilised by clinicians practising in the Children's Heart Program of South Carolina. For both pre-operative and post-operative variables, we speculate that patients who were not doing well with medical management were likely referred for surgery sooner, ultimately leading to equivalent outcomes among the age groups.…”

Transcatheter Edge-to-Edge Repair for Left Atrioventricular Valve Cleft After Previously Repaired Complete Atrioventricular Canal Defect in Down Syndrome

“… 2 , 3 Patients with Down syndrome (DS) have a relatively higher incidence of atrioventricular septal defects (AVSDs) and concomitant cleft mitral/atrioventricular valve (AVV) leaflets potentially requiring multiple surgical repairs in childhood, thus placing them at higher risk of additional complications in adulthood. 4 , 5 , 6 , 7 Prior case reports have demonstrated the use of TEER in cases of cleft mitral leaflets, highlighting possible interventional approaches to achieve an effective repair. 8 , 9 , 10 , 11 , 12 , 13 Here we present a case with prior surgical repair of a complete atrioventricular canal (CAVC) defect with left AVV cleft who underwent successful TEER for severe regurgitation.…”