Incidence and outcomes of left atrioventricular valve reoperation following atrioventricular septal defect repair

OBJECTIVE: Surgery for left atrioventricular valve after initial atrioventricular septal defect repair remains challenging. This study aimed to characterize patients requiring the left atrioventricular valve reoperation and to analyze its outcomes and risks. METHODS: Patients undergoing left atrioventricular valve reoperations after an atrioventricular septal defect repair between 2001 and 2024 were reviewed. The cumulative incidence of left atrioventricular valve reoperation and death was reported using a competing risk model, and risk factors for each outcome were identified using cause-specific Cox proportional regression. RESULTS: Of 638 patients with an atrioventricular septal defect repair (418 complete, 29 intermediate, 192 partial), 63 (9.9%) required left atrioventricular valve reoperation, including 45 repairs and 18 replacements. Median ages at an atrioventricular septal defect repair and at the left atrioventricular valve reoperation were 5.6 (interquartile range, 4.2-13.7) months and 1.4 (interquartile range, 0.5-5.9) years. The cumulative incidence of the left atrioventricular valve reoperation after atrioventricular septal defect repair at 5, 10, and 15 years was 9%, 11%, and 12%, respectively. Among 63 patients, 20 (33.3%) required further left atrioventricular valve reoperations (3 re-repairs and 17 replacements) after a median duration of 2.2 (interquartile range, 0.5-12.2) years. Cumulative incidence of re-left atrioventricular valve reoperation at 3, 5, and 10 years was 16.8%, 20.5%, and 31.7%, respectively. Borderline unbalanced small left ventricle (hazard ratio, 4.995, P < .001), postoperative left atrioventricular valve regurgitation (hazard ratio, 3.041, P < .001), and postoperative left ventricular outflow tract obstruction (hazard ratio, 4.034, P = .022) were risk factors for left atrioventricular valve reoperation. CONCLUSIONS: Left atrioventricular valve reoperation was required in 9.9% of the patients after atrioventricular septal defect repair. The cumulative incidence of re-left atrioventricular valve reoperations after the left atrioventricular valve reoperation was relevant, requiring an alternative strategy in this cohort of patients.