Reoperation for Left Atrioventricular Valve Regurgitation After Atrioventricular Septal Defect Repair

• Published in: The Annals of thoracic surgery Vol. 86; no. 1; pp. 147 - 152
• Main Authors: Malhotra, Sunil P., MD, Lacour-Gayet, Francois, MD, Mitchell, Max B., MD, Clarke, David R., MD, Dines, Marshall L., BS, Campbell, David N., MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.07.2008
• Subjects: Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Cardiothoracic Surgery; Child, Preschool; Cohort Studies; Female; Follow-Up Studies; Heart Septal Defects, Ventricular - diagnostic imaging; Heart Septal Defects, Ventricular - surgery; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Humans; Infant; Kaplan-Meier Estimate; Male; Mitral Valve Insufficiency - etiology; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - surgery; Postoperative Complications - mortality; Postoperative Complications - surgery; Reoperation; Retrospective Studies; Risk Assessment; Surgery; Survival Analysis; Time Factors; Treatment Outcome; Ultrasonography; 20
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2008.03.040

Background Left atrioventricular valve regurgitation (LAVVR) is a major cause of morbidity after atrioventricular septal defect (AVSD) repair. This study evaluates the outcomes of repair and replacement of the left atrioventricular valve after AVSD correction, as well as factors predictive of durability of valve repair. Methods Between January 1983 and March 2007, 31 patients underwent reoperation for LAVVR after AVSD repair (23 valve repairs and 8 valve replacements). Median age at primary repair was 5.0 months and time to reoperation was 5.0 months. The distribution of AVSD morphology was 9 primum, 5 transitional, and 17 complete. Results Early postoperative mortality was 6.4% (2 of 31). Survival at 10 years was 88.1%. At a mean follow-up of 8.2 years, 86% of hospital survivors were in New York Heart Association class I. Overall freedom from reintervention at 10 years was 67.2%. Among patients undergoing primary repair, 6 of 23 underwent subsequent replacement. Follow-up LAVVR in those who did not require subsequent valve replacement was mild or less in 92.8%. Factors that demonstrated a trend toward durable repair included the use of patch augmentation rather than primary cleft closure ( p = 0.02) and earlier timing to repair (less than 2 months; p = 0.03). Significant cardiomyopathy developed in 21.4% of patients after prosthetic valve replacement (3 of 14). Conclusions Surgical management of LAVVR after AVSD repair can be performed with excellent midterm outcomes. However, both repair and replacement are associated with a high incidence of reoperation. Nonetheless, an aggressive reparative approach should be pursued to avoid the morbidity of pediatric left atrioventricular valve replacement that includes anticoagulation, inevitable reoperation, and cardiomyopathy.