Results of Definitive Repair of Complete Atrioventricular Septal Defect in Neonates and Infants

• Published in: The Annals of thoracic surgery Vol. 86; no. 2; pp. 596 - 602
• Main Authors: Suzuki, Takaaki, MD, Bove, Edward L., MD, Devaney, Eric J., MD, Ishizaka, Toru, MD, Goldberg, Caren S., MD, Hirsch, Jennifer C., MD, Ohye, Richard G., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2008; Elsevier Science
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Echocardiography, Doppler; Female; Heart; Heart Septal Defects, Atrial - mortality; Heart Septal Defects, Atrial - surgery; Heart Septal Defects, Ventricular - mortality; Heart Septal Defects, Ventricular - surgery; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Hospital Mortality; Humans; Infant; Infant, Newborn; Male; Medical sciences; Pneumology; Retrospective Studies; Risk Factors; Surgery; Survival Analysis; Treatment Outcome; Ventricular Outflow Obstruction - surgery; 21; Human; Corrective surgery; Complete; Cardiovascular disease; Infant; Congenital disease; Result; Newborn; Treatment; Malformation; Heart disease; Anesthesia; Circulatory system; Endocardial cushion defect; Cardiology; Repair
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2008.02.032

Background Early surgical intervention for complete atrioventricular septal defect (AVSD) has contributed to a decline in postoperative mortality. Methods We retrospectively evaluated outcomes in 116 complete AVSD patients undergoing definitive repair from February 1997 through October 2002. Patients with an unbalanced AVSD not suitable for biventricular repair, tetralogy of Fallot, or double-outlet right ventricle were excluded. Results Median age at operation was 4.8 months (range, 9 days to 5.4 years); weight was 4.8 kg (range, 2.1 to 23 kg). Follow-up was 93% complete (mean, 27 months; range, 1 to 73 months). Early definitive repairs were performed in 98% (110 of 112) of patients initially presenting to our institution. Ninety-two patients (79%) underwent repair before 6 months of age, including 25 (22%) before 3 months. Actuarial survival at 1, 3, and 5 years was 98%, 95%, and 95%, respectively. Seventy-five patients (68%) had trivial to mild left AV valve regurgitation at discharge; moderate or severe left AV valve stenosis developed in 3 (3%). Actuarial freedom from reoperation for left AV valve dysfunction at 1, 3, and 5 years was 94%, 89%, and 89%, respectively. Actuarial freedom from reoperation for left ventricular outflow tract obstruction at 1, 3, and 5 years was 100%, 93%, and 90%, respectively. Conclusions Definitive repair for complete AVSD can be performed in early infancy with excellent results. The two-patch technique is a safe and reproducible surgical method that can achieve low mortality and good midterm outcomes even in very young infants.