Key result
Primary biventricular repair of partial or transitional AVSD linked to ~0.4-unit weight z-score improvement.
Why the study?
Surgical and perioperative improvements permit earlier repair of partial and transitional AVSD, but contemporary multicenter outcomes needed description.
Does primary biventricular repair improve weight-for-age z-scores and cardiac function in children with partial or transitional AVSD?
Cohort (n=87)
Yes
Does primary biventricular repair improve weight-for-age z-scores and cardiac function in children with partial or transitional AVSD?
Effect estimate: median increase of 0.4 units
p-value: p=<0.001
Surgical repair of partial/transitional AVSD in young children is safe and promotes catch-up growth, though significant LAVVR remains a common residual defect.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“There remains a lack of evidence-based guidelines for optimal frequency of follow-up and testing in patients with AVSD, either before or following surgical intervention, leading to wide variation in clinical practice and resource utilization.”
Supports catch-up growth after repair in underweight infants; leaves open optimal timing and valve outcomes in prospective studies.
Background Surgical and perioperative improvements permit earlier repair of partial and transitional atrioventricular septal defects (AVSD). We sought to describe contemporary outcomes in a multicenter cohort. Methods We studied 87 patients undergoing primary biventricular repair of partial or transitional AVSD between June 2004 and February 2006 across seven North American centers. One-month and 6-month postoperative data included weight-for-age z-scores, left atrioventricular valve regurgitation (LAVVR) grade, residual shunts, and left ventricular ejection fraction. Paired methods were used to assess 6-month change. Results Median age at surgery was 1.8 years; median weight z-score was −0.88. Median days for ventilation were 1, intensive care 2, and hospitalization 5, all independent of age, with 1 in-hospital death. At 1 month, 27% (16 of 73) had ejection fraction less than 55%; 20% (17 of 87) had significant LAVVR; 2 had residual shunts; 1 each had subaortic stenosis and LAVV stenosis. At 6 months (n = 60), there were no interim deaths, reinterventions, or new development of subaortic or LAVV stenosis. Weight z-score improved by a median 0.4 units (p < 0.001), especially for underweight children less than 18 months old. Left atrioventricular valve regurgitation occurred in 31% (change from baseline, p = 0.13), occurring more frequently in patients repaired at 4 to 7 years (p = 0.01). Three patients had ejection fraction less than 55%, and 1 had a residual atrial shunt. Conclusions Surgical repair for partial/transitional AVSD is associated with low morbidity and mortality, short hospital stays, and catch-up growth, particularly in underweight children repaired between 3 and 18 months of age. Left atrioventricular valve regurgitation remains the most common residual defect, occurring more frequently in children repaired after 4 years of age.
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Minich et al. (2010) conducted a cohort in Partial or transitional atrioventricular septal defect (AVSD) (n=87). Primary biventricular repair was evaluated on Change in weight-for-age z-score at 6 months (median increase of 0.4 units, p=<0.001). Primary biventricular repair of partial or transitional AVSD was associated with a median weight z-score improvement of 0.4 units at 6 months (p<0.001).
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