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Kobayashi Y, Kasahara S, Sano S, Kotani Y. Modified single-patch repair for atrioventricular septal defects results in good functional outcomes in the absence of deep ventricular septal defects. J Thorac Cardiovasc Surg 2023; 165:411-421. [PMID: 36115701 DOI: 10.1016/j.jtcvs.2022.07.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/03/2022] [Accepted: 07/21/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES We compared 2-patch repair (TP) with modified single-patch repair (MSP) for complete atrioventricular septal defects and evaluated their effect on the left atrioventricular valve (LAVV) competence. We also identified risk factors for unfavorable functional outcomes. METHODS This retrospective study included 118 patients with complete atrioventricular septal defects who underwent intracardiac repair from 1998 to 2020 (MSP: 69; TP: 49). The median follow-up period was 10.4 years. The functional outcome of freedom from moderate or greater LAVV regurgitation (LAVVR) was estimated using the Kaplan-Meier method. RESULTS The hospital mortality was 1.7% (2/118) and late mortality was 0.8% (1/118). Eight patients required LAVV-related reoperation (MSP: 4; TP: 4) and none required left ventricular outflow tract-related reoperation. In the MSP group without LAVV anomaly, the receiver operating characteristic curve analysis revealed that the ventricular septal defect (VSD) depth was strongly associated with moderate or greater postoperative LAVVR, with the best cutoff at 10.9 mm. When stratified according to the combination of intracardiac repair type and VSD depth, the MSP-deep VSD (VSD depth >11 mm) group showed the worst LAVV competence among the 4 groups (P = .002). According to multivariate analysis, weight <4.0 kg, LAVV anomaly, and moderate or greater preoperative LAVVR were independent risk factors for moderate or greater postoperative LAVVR, whereas MSP was not a risk factor. CONCLUSIONS Postoperative LAVVR remains an obstacle to improved functional outcomes. MSP provides LAVV competence similar to TP unless deep VSD is present. The surgical approach should be selected on the basis of anatomical variations, specifically VSD depth.
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Affiliation(s)
- Yasuyuki Kobayashi
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan
| | - Shunji Sano
- Pediatric Cardiothoracic Surgery, University of California, San Francisco, San Francisco, Calif
| | - Yasuhiro Kotani
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan.
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Al-Wassia HK, Al-Radi OO, Maghrabi KA, Bayazeed MA, Qattan MM, Ebraheem DT, Gadi SU, Kattan MF, Alghamdi RA, Alzabidi SH, Dohain AM. The influence of age and weight on the outcomes of complete atrioventricular septal defect repair. Egypt Heart J 2022; 74:55. [PMID: 35849194 PMCID: PMC9294084 DOI: 10.1186/s43044-022-00292-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The appropriate age and weight for surgical repair of atrioventricular septal defect (AVSD) is an area of controversy. We aimed to study the effect of weight and age at the time of surgical repair for complete AVSD in children less than 2 years of age on postoperative outcomes. A retrospective data review was performed for patients who underwent the AVSD repair from 2012 to 2019 at our institutions. Our primary outcome was the postoperative in-hospital length of stay (LOS). Secondary outcomes included total positive pressure ventilation (PPV), ventilation time, maximum vasoactive–inotropic score (max VIS), and other postoperative complications.
Results
The study included fifty patients. The median age was 191 days, and the median weight was 4.38 kg at the time of surgery. Weight < 4 kg was associated with longer PPV time and postoperative in-hospital LOS (p value of 0.033 and 0.015, respectively). Additionally, they had higher max VIS at 24 h and 48 h than the other groups with bodyweight 4–5.9 kg or ≥ 6 kg (p value of 0.05 and 0.027, respectively). Patients with older age or lower weight at operation had a longer in-hospital LOS and total length of PPV after surgery. There were no postoperative in-hospital deaths.
Conclusions
Older age and lower weight at the time of surgical repair of atrioventricular septal defect could be independent predictors of prolonged postoperative in-hospital length of stay and total length of positive pressure ventilation.
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Paediatrician's guide to post-operative care for biventricular CHD: a review. Cardiol Young 2022; 32:1721-1727. [PMID: 36165406 DOI: 10.1017/s1047951122002955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
IMPORTANCE Paediatricians play an integral role in the lifelong care of children with CHD, many of whom will undergo cardiac surgery. There is a paucity of literature for the paediatrician regarding the post-operative care of such patients. OBSERVATIONS The aim of this manuscript is to summarise essential principles and pertinent lesion-specific context for the care of patients who have undergone surgery or intervention resulting in a biventricular circulation. CONCLUSIONS AND RELEVANCE Familiarity with common issues following cardiac surgery or intervention, as well as key details regarding specific lesions and surgeries, will aid the paediatrician in providing optimal care for these patients.
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Ohuchi H, Kawata M, Uemura H, Akagi T, Yao A, Senzaki H, Kasahara S, Ichikawa H, Motoki H, Syoda M, Sugiyama H, Tsutsui H, Inai K, Suzuki T, Sakamoto K, Tatebe S, Ishizu T, Shiina Y, Tateno S, Miyazaki A, Toh N, Sakamoto I, Izumi C, Mizuno Y, Kato A, Sagawa K, Ochiai R, Ichida F, Kimura T, Matsuda H, Niwa K. JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair. Circ J 2022; 86:1591-1690. [DOI: 10.1253/circj.cj-22-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Masaaki Kawata
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Hideaki Senzaki
- Department of Pediatrics, International University of Health and Welfare
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Syoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University
| | | | - Syunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yumi Shiina
- Cardiovascular Center, St. Luke’s International Hospital
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiko Mizuno
- Faculty of Nursing, Tokyo University of Information Sciences
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke’s International Hospital
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Stephens EH, Backer CL. Teaching the Modified Single-Patch Technique for Complete Atrioventricular Septal Defect. World J Pediatr Congenit Heart Surg 2022; 13:371-375. [PMID: 35446220 DOI: 10.1177/21501351221081257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Understanding the morphology of atrioventricular septal defects and learning the operative strategies for their repair is one of the more difficult tasks for congenital cardiac surgery residents to master. The modified single-patch technique for several reasons lends itself to being a strategy that is relatively easy to teach residents. It has shorter cross-clamp and bypass times than the standard two-patch technique, which allows more time for the instructor to safely take the resident through the case. The steps of the operation are quite standard and broadly applicable to the wide variety of cardiac morphologies found in children with atrioventricular septal defects. The purpose of this review is to carefully point out the technical details of each step of the modified single-patch technique focusing on teaching the resident surgeon. The ease of teaching this excellent technique is just another reason to use the modified single-patch technique.
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Affiliation(s)
| | - Carl L Backer
- Section of Pediatric Cardiothoracic Surgery, 177468UK Healthcare Kentucky Children's Hospital, Lexington, KY, USA.,Cardiothoracic Surgery, Heart Institute, 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Kim MJ, Cha S, Baek JS, Yu JJ, Kim DH, Choi ES, Kwon BS, Yun TJ, Park CS. Contemporary outcomes after pulmonary artery banding in complete atrioventricular septal defect. Ann Thorac Surg 2022; 114:2356-2362. [PMID: 35405104 DOI: 10.1016/j.athoracsur.2022.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/17/2022] [Accepted: 03/22/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND This study investigated the clinical outcomes and the effect of band tightness on outcome after pulmonary artery banding (PAB) in patients with complete atrioventricular septal defect (AVSD). METHODS From 2000 through 2019, among 133 patients with isolated complete AVSD pursuing biventricular repair, 34 patients (25.6%) who underwent PAB were included in this study. Factors associated with adverse outcome, which was defined as prolonged stay in the intensive care unit (ICU) (> 10 days), were analysed using multiple logistic regression model. Receiver operating characteristic (ROC) analysis was performed to identify a threshold band tightness for adverse outcome. RESULTS The median age and weight were 43 days and 3.6kg, respectively. There were 4 early deaths. The median ICU stay was 8 days. Twenty-eight patients (28/34, 82.4%) underwent corrective surgery 10 months (IQR 7∼12 months) after PAB. In multivariable analysis, indexed band diameter was identified as a factor associated with adverse outcome (odds ratio 1.60, 95% confidence interval 1.03-2.48; p=0.035). ROC analysis indicated 22.2 mm/m2 of indexed PAB diameter measured at discharge as a threshold band tightness for adverse outcome (area under curve 0.871, p<0.001). The level of B-type natriuretic peptide similarly decreased after PAB regardless of band tightness, although the probability of worsening in atrioventricular valve regurgitation (AVVR) was significantly decreased in patients with tighter band (p=0.027). CONCLUSIONS PAB is a viable option for patients with early presenting complete AVSD. Tighter PAB might be beneficial for early postoperative outcomes and preventing progression of AVVR in complete AVSD.
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Affiliation(s)
| | | | | | | | - Dong-Hee Kim
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun Seok Choi
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bo Sang Kwon
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae-Jin Yun
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chun Soo Park
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Contemporary surgical management of complete atrioventricular septal defect with tetralogy of Fallot in Japan. Gan To Kagaku Ryoho 2022; 70:835-841. [PMID: 35332445 DOI: 10.1007/s11748-022-01809-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/12/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Complete atrioventricular septal defect with tetralogy of Fallot is a rare and complex heart disease. This study aimed to describe contemporary management approaches for this heart disease and the outcomes. METHODS Data were obtained from 46 domestic institutions in the Japan Cardiovascular Database (2011-2018). Patients with a fundamental diagnosis of complete atrioventricular septal defect with tetralogy of Fallot, without other complex heart diseases, were included. The primary outcome was operative mortality (30-day or in-hospital mortality). RESULTS A total of 119 patients underwent initial surgery for a complete atrioventricular septal defect with tetralogy of Fallot during this study period. Primary repair was performed in 40 (34%) patients (primary repair group), and palliative procedure was performed in 79 (66%) patients as part of a planned staged approach (staged group). Forty institutions (87%) experienced at least one case of staged repair. No institution experienced more than or equal to two cases/year on average during the study period. Overall, 11 operative mortalities occurred (9.2%). Operative mortality rates in the primary and staged groups were comparable (p = 0.5). Preoperative catecholamine use, repeat palliative surgeries, and emergency admission were significant risk factors for operative mortality in multivariate analysis (odds ratio, 95% confidence interval: 8.58, [0-0.11]; 12.65, [1.28-125.15]; 8.64, [1.87-39.32, respectively]). CONCLUSIONS Staged approach for complete atrioventricular septal defect with tetralogy of Fallot was the preferred option. The outcomes of this complex disease were favorable for patients in centers with low cases of complete atrioventricular septal defect with tetralogy of Fallot.
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8
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Trifoliate left atrioventricular valve with and without intact septal structures in four dogs: echocardiographic findings and surgical repair. J Vet Cardiol 2022; 41:70-78. [DOI: 10.1016/j.jvc.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 11/22/2022]
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Mikulski MF, Mery CM. Commentary: Down or non-Down: It all comes down to the details. J Thorac Cardiovasc Surg 2021; 163:1446-1447. [PMID: 34610860 DOI: 10.1016/j.jtcvs.2021.08.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Matthew F Mikulski
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Tex
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Tex; Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Tex.
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10
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Buratto E, Lui A, Hu T, Naimo P, Ivanov Y, d'Udekem Y, Brizard CP, Konstantinov IE. Propensity score matched analysis of cleft closure in complete atrioventricular septal defect repair. Ann Thorac Surg 2021; 113:1553-1561. [PMID: 34487709 DOI: 10.1016/j.athoracsur.2021.07.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/02/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Repair of complete atrioventricular septal defect (cAVSD) is achieved with low mortality. However, there is a high rate of reoperation on the left atrioventricular valve (LAVV), which is often attributed to non-closure of the cleft. Although non-closure of the cleft has been reported to be a risk factor for reoperation, no randomized-controlled or propensity-matched trials have ever been performed. We investigated the effect of cleft closure on outcomes following cAVSD repair. METHODS We reviewed 455 patients who underwent cAVSD repair between 1990 and 2019. To determine the effect of cleft closure, propensity score matching was performed on risk factors for reoperation following cAVSD repair. RESULTS Median age was 3.6 months (mean 9.6±20.4), median weight was 4.3 kg (mean 4.7±4.3kg) and 41.9% (191/455) were male. Early mortality was 2.9% (13/455), and survival was 89.8±1.9% at 20 years. Early reoperation was a risk factor for mortality (p=0.004). Freedom from reoperation was 72.5±4.0% at 20 years. Freedom from LAVV reoperation was 74.1±4.0% at 20 years. Preoperative severe LAVV regurgitation (p<0.001) and early postoperative moderate or greater LAVV regurgitation (p=0.007) were risk factors for reoperation, while trisomy 21 (p=0.03) and recent era of surgery (p=0.02) were protective. Propensity score matching yielded 106 pairs. There were no differences in long-term survival (p=0.71) or reoperation (p=0.26) between the two groups. CONCLUSIONS Repair of cAVSD can be achieved with low mortality and good long-term survival, however, the reoperation rate remains high. Similar freedom from reoperation can be achieved with or without closure of the LAVV cleft.
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Affiliation(s)
- Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne
| | - Adrienne Lui
- Department of Paediatrics, University of Melbourne, Melbourne
| | - Thomas Hu
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne
| | - Phillip Naimo
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne
| | - Yaroslav Ivanov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne.
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Ramgren JJ, Zindovic I, Nozohoor S, Gustafsson R, Hakacova N, Sjögren J. Impact of concomitant complex cardiac anatomy in nonsyndromic patients with complete atrioventricular septal defect. J Thorac Cardiovasc Surg 2021; 163:1437-1444. [PMID: 34503843 DOI: 10.1016/j.jtcvs.2021.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/01/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We studied a cohort of patients with nonsyndromic complete atrioventricular septal defect with and without concomitant complex cardiac anatomy and compared the outcomes after surgical repair. METHODS Between 1993 and 2018, 62 nonsyndromic patients underwent complete atrioventricular septal defect repair. Sixteen patients (26%) had complex complete atrioventricular septal defect with variables representing concomitant cardiac anatomic complexity: tetralogy of Fallot, double outlet right ventricle, total anomalous pulmonary venous return, concomitant aortic arch reconstruction, multiple ventricular septal defects, staged repair of coarctation of the aorta, and a persisting left superior vena cava. The mean follow-up was 12.7 ± 7.9 years. Baseline variables were retrospectively evaluated and analyzed using univariable logistic regression. Survival was studied using Kaplan-Meier estimates, and group comparisons were performed using the log-rank test. A competing-risk analysis estimated the risk of reoperation with death as the competing event. A Gray's test was used to test equality of the cumulative incidence curves between groups. RESULTS The perioperative mortality was 3.2% (2/62). Actuarial survival was 100% versus 66.7% ± 14.9% at 10 years in the noncomplex and complex groups, respectively (P < .01). There was no significant difference in the overall reoperation rate between the noncomplex group (7/46; 15%) and the complex group (4/16; 25%) (odds ratio, 1.86; 95% confidence interval, 0.46-7.45; P = .30). The competing-risk analysis demonstrated no significant difference in reoperation between the groups (P = .28). CONCLUSIONS Our data show that nonsyndromic patients without complex cardiac anatomy have a good long-term survival and an acceptable risk of reoperation similar to contemporary outcomes for patients with complete atrioventricular septal defect with trisomy 21. However, the corresponding group of nonsyndromic patients with concomitant complex cardiac lesions are still a high-risk population, especially regarding mortality.
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Affiliation(s)
- Jens Johansson Ramgren
- Section for Pediatric Cardiac Surgery, Department of Pediatrics, Lund University and Children's Hospital, Skane University Hospital, Lund, Sweden.
| | - Igor Zindovic
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skane University Hospital, Lund, Sweden
| | - Shahab Nozohoor
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skane University Hospital, Lund, Sweden
| | - Ronny Gustafsson
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skane University Hospital, Lund, Sweden
| | - Nina Hakacova
- Department of Pediatrics, Lund University and Children's Hospital, Skane University Hospital, Lund, Sweden
| | - Johan Sjögren
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skane University Hospital, Lund, Sweden
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Well A, Beckerman Z. Commentary: An ounce of prevention is worth a pound of cure. JTCVS Tech 2021; 7:249-250. [PMID: 34318264 PMCID: PMC8312083 DOI: 10.1016/j.xjtc.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andrew Well
- Division of Pediatric and Congenital Cardiothoracic Surgery, Department of Surgery and Perioperative Care, University of Texas Dell Medical School and Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Tex
| | - Ziv Beckerman
- Division of Pediatric and Congenital Cardiothoracic Surgery, Department of Surgery and Perioperative Care, University of Texas Dell Medical School and Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Tex
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13
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Early repair of complete atrioventricular septal defect has better survival than staged repair after pulmonary artery banding: A propensity score–matched study. J Thorac Cardiovasc Surg 2021; 161:1594-1601. [DOI: 10.1016/j.jtcvs.2020.07.106] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/13/2020] [Accepted: 07/31/2020] [Indexed: 11/23/2022]
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Ramgren JJ, Nozohoor S, Zindovic I, Gustafsson R, Hakacova N, Sjögren J. Long-term outcome after early repair of complete atrioventricular septal defect in young infants. J Thorac Cardiovasc Surg 2020; 161:2145-2153. [PMID: 32919770 DOI: 10.1016/j.jtcvs.2020.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The long-term outcome after repair of complete atrioventricular septal defect in young infants is still not fully understood. The objective of this study was to evaluate data after repair for complete atrioventricular septal defect over a 25-year period to assess survival and identify risk factors for left atrioventricular valve-related reoperations. METHODS A total of 304 consecutive patients underwent surgical correction for complete atrioventricular septal defect between April 1993 and October 2018. The results for young infants (aged <3 months; n = 55; mean age 1.6 ± 0.6 months) were compared with older infants (aged >3 months; n = 249; mean age, 5.1 ± 5.2 months). Mean follow-up was 13.2 ± 7.8 years (median, 14.0 years; interquartile range, 7.0-20.0). The Kaplan-Meier method was used to assess overall survival and freedom from left atrioventricular valve-related reoperation. RESULTS Overall, 30-day mortality was 1.0% (3/304) with no difference between young and older infants (P = 1.0). Overall survival in the total population at 20-year follow-up was 95.1% (±1.3%). Independent risk factors for poor survival were the presence of an additional ventricular septal defect (P = .042), previous coarctation of the aorta (P < .001), persistent left superior vena cava (P = .026), and genetic syndromes other than Trisomy 21 (P = .017). Freedom from left atrioventricular valve-related reoperation was 92.6% (±1.7%) at 20 years. There was no significant difference in left atrioventricular valve-related reoperation in young infants compared with older infants (P = .084). CONCLUSIONS Our data demonstrated that excellent long-term survival could be achieved with early repair for complete atrioventricular septal defect, and the need for reoperations due to left atrioventricular valve regurgitation was low. Primary correction in patients aged less than 3 months is, when clinically necessary, well tolerated. Palliative procedures can be avoided in the majority of patients.
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Affiliation(s)
- Jens Johansson Ramgren
- Section for Pediatric Cardiac Surgery, Department of Pediatrics, Lund University and Children's Hospital, Skane University Hospital, Lund, Sweden.
| | - Shahab Nozohoor
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skane University Hospital, Lund, Sweden
| | - Igor Zindovic
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skane University Hospital, Lund, Sweden
| | - Ronny Gustafsson
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skane University Hospital, Lund, Sweden
| | - Nina Hakacova
- Department of Pediatric Cardiology, Lund University and Children's Hospital, Skane University Hospital, Lund, Sweden
| | - Johan Sjögren
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skane University Hospital, Lund, Sweden
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15
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Staged repair of transposition of the great arteries with anomalous coronary anatomy and complete atrioventricular canal. Cardiol Young 2020; 30:1188-1190. [PMID: 32616111 DOI: 10.1017/s1047951120001614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The association of complete atrioventricular canal with transposition of the great arteries is rare, with a prevalence of less than 3-5%. We present an 18-month-old patient with a complete atrioventricular canal, side-by-side transposition of the great arteries, and anomalous coronary anatomy, managed initially with pulmonary banding and then by arterial switch with complete atrioventricular canal repair at early infancy.
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16
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"Repair of common atrioventricular junction in isolation and when associated with other congenital heart defects". Indian J Thorac Cardiovasc Surg 2020; 37:54-66. [PMID: 33584027 DOI: 10.1007/s12055-020-00947-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022] Open
Abstract
Management of atrioventricular septal defects has grown leaps and bounds since the first correction of this malformation. Main reasons considered for the improvement are good understanding of lesion anatomy, precise preoperative diagnosis including imaging, progress in surgical technique, myocardial protection, and post-operative care. In this article we review the anatomy, pathophysiology, clinical features, associations, diagnosis, surgical therapy, complications, and results of atrioventricular septal defects.
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17
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Management of the bad atrioventricular valve in Fontan…time for a change. J Thorac Cardiovasc Surg 2019; 158:1643-1648. [DOI: 10.1016/j.jtcvs.2019.08.129] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/01/2019] [Accepted: 08/11/2019] [Indexed: 11/21/2022]
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