Key result
Primary two-patch repair of CAVSD yields ~93% ten-year survival.
Why the study?
Does primary repair of CAVSD using a two-patch technique provide good long-term survival and low reoperation rates in pediatric patients?
Cohort (n=97)
Does primary repair of CAVSD using a two-patch technique provide good long-term survival and low reoperation rates in pediatric patients?
Primary two-patch repair of complete atrioventricular septal defect yields excellent 10-year survival (93%) and low need for prosthetic valve implantation.
Supports two-patch CAVSD repair durability in children; leaves open randomized comparisons to alternative techniques.
OBJECTIVE: The policy of primary repair of complete atrioventricular septal defect (CAVSD), using a two-patch technique, was evaluated with special attention to the risk of implantation of a prosthetic atrioventricular (AV) valve. METHODS: From 1986 to 1999, all 97 patients who underwent primary repair for CAVSD were included in a retrospective analysis. Seventy-five patients (75%) had Down's syndrome. Preoperative echocardiographic AV valve regurgitation was absent or limited in 85 (88%), moderate in seven (7%) and severe in five (5%). Fifty-six patients (58%) were on diuretics, six (6%) on artificial ventilation and four (4%) were on inotropic support. The mean age at operation was 10.2 months (SD, 16.4), with a mean weight of 5.9 kg (SD, 3.7). RESULTS: Early mortality comprised three patients (4%), and late mortality two patients. Follow up was complete and comprised 402 patient-years (mean, 4.5 years; SD, 3.2). The cumulative survival at 10 years was 93% (95% CI, 89-97%). Multivariate analysis with regard to mortality revealed no associations with any of the analyzed factors. Eight patients were reoperated, all for regurgitant left AV valve. The reoperation-free survival at 10 years was 83% (95% CI, 75-91%). Multivariate analysis with regard to reoperation showed being on preoperative diuretics to be a decreasing risk factor (Odd's Ratio (OR), 0.13; 95% CI, 0.00-0. 99; P=0.005) and significant postoperative left AV valve regurgitation to be an increasing risk factor (OR, 9.90; 95% CI, 1. 90-53.0; P=0.001). Only one prosthetic valve was implanted (annual linearized risk of 0.002/patient-year). At the latest follow up of the surviving patients, left AV valve regurgitation was absent or limited in 83 (90%) and moderate in nine (10%). Right AV valve regurgitation was absent or limited in all 92 (100%) patients. All surviving patients are thriving well, seven (8%) of whom are on diuretics. CONCLUSIONS: Primary repair of CAVSD with a two-patch technique, including cleft closure of the left AV valve, has good clinical and functional results without problems for the right-sided AV valve. The need for prosthetic valve implantation for the left AV valve is minimal.
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Bogers et al. (2000) conducted a cohort in Complete atrioventricular septal defect (n=97). Primary two-patch repair was evaluated on Cumulative survival at 10 years (95% CI 89-97). Primary two-patch repair of complete atrioventricular septal defect yielded a 10-year cumulative survival of 93% (95% CI 89-97%) and a 10-year reoperation-free survival of 83%.
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