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Ozturk M, Tongut A, Sterzbecher V, Desai M, Esmailian G, Henmi S, Spurney C, Staffa SJ, d’Udekem Y, Yerebakan C. Repair of the complete atrioventricular septal defect-impact of postoperative moderate or more regurgitation. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae053. [PMID: 38569897 PMCID: PMC11055535 DOI: 10.1093/icvts/ivae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/22/2023] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES To study the risk factors for mortality, moderate or more left atrioventricular valve regurgitation (LAVVR) and reoperation after the surgical repair of complete atrioventricular septal defect (cAVSD) in a single centre. METHODS The current study is a retrospective review of patients who underwent surgical repair of cAVSD between 2000 and 2021. Patients with unbalanced ventricles not amenable to biventricular repair, double outlet right ventricle and malpositioned great arteries were excluded. The clinical predictors of outcome for end points were analysed with univariate and multivariable Cox regression analysis or Fine-Gray modelling for competing risks. Time-dependent end points were estimated using the Kaplan-Meier curve analysis and cumulative incidence curves. RESULTS The median follow-up time was 2.3 years. Among 220 consecutive patients were 10 (4.6%) operative and 21 late mortalities (9.6%). A total of 26 patients were identified to have immediate postoperative moderate or more regurgitation and 10 of them ultimately died. By multivariable analysis prematurity and having more than moderate regurgitation immediately after the operation were identified as predictors of overall mortality (P = 0.003, P = 0.012). Five- and ten-year survival rates were lower for patients with immediate postoperative moderate or more LAVVR {51.9% [confidence interval (CI): 27.5-71.7%]} when compared to patients without moderate or more regurgitation [93.2% (CI: 87.1-96.4%) and 91.3% (CI: 83.6-95.5%)]. CONCLUSIONS The patients who undergo cAVSD repair remain subjected to a heavy burden of disease related to postoperative residual LAVVR. Immediate postoperative moderate or more LAVVR contributes significantly to overall mortality. Whether a second run of bypass can decrease this observed mortality should be investigated.
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Affiliation(s)
- Mahmut Ozturk
- Division of Cardiac Surgery, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Aybala Tongut
- Division of Cardiac Surgery, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Vanessa Sterzbecher
- Division of Cardiac Surgery, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Manan Desai
- Division of Cardiac Surgery, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Gabriel Esmailian
- Division of Cardiac Surgery, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Soichiro Henmi
- Division of Cardiac Surgery, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Christopher Spurney
- Division of Cardiology, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yves d’Udekem
- Division of Cardiac Surgery, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Can Yerebakan
- Division of Cardiac Surgery, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Thanh Xuan N, Xuan Hung N, Hoai An T, Dang Phuoc N, Huu Son N, Nhu Hiep P. <p>Treatment of Isolated Complete Atrioventricular Septal Defect: The Hue Central Hospital Experience</p>. OPEN ACCESS SURGERY 2020. [DOI: 10.2147/oas.s255267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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3
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Houck CA, Evertz R, Teuwen CP, Roos-Hesselink JW, Kammeraad JAE, Duijnhouwer AL, de Groot NMS, Bogers AJJC. Dysrhythmias in patients with a complete atrioventricular septal defect: From surgery to early adulthood. CONGENIT HEART DIS 2018; 14:280-287. [PMID: 30485659 PMCID: PMC7379716 DOI: 10.1111/chd.12724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/25/2018] [Accepted: 11/03/2018] [Indexed: 11/29/2022]
Abstract
Objective Outcomes after surgical repair of complete atrioventricular septal defect (cAVSD) have improved. With advancing age, the risk of development of dysrhythmias may increase. The aims of this study were to (1) examine development of sinus node dysfunction (SND), atrial and ventricular tachyarrhythmias, and (2) study progression of atrioventricular conduction abnormalities in young adult patients with repaired cAVSD. Study design In this retrospective multicenter study, 74 patients (68% female) with a cAVSD repaired in childhood were included. Patients’ medical files were evaluated for occurrence of SND, atrioventricular conduction block (AVB), atrial and ventricular tachyarrhythmias. Results Median age at repair was 6 months (interquartile range 3‐10) and median age at last follow‐up was 24 years (interquartile range 21‐28). SND occurred after a median of 17 years (interquartile range 11‐19) after repair in 23% of patients, requiring pacemaker implantation in two patients (12%). Regular supraventricular tachycardia was observed in three patients (4%). Atrial fibrillation and ventricular tachyarrhythmias were not observed. Twenty‐seven patients (36%) had first‐degree AVB, which was self‐limiting in 16 (59%) and persistent in 10 (37%) patients. One patient developed third‐degree AVB 7 days after left atrioventricular valve replacement. Spontaneous type II second‐degree AVB occurred in a 28‐year‐old patient. Both patients underwent pacemaker implantation. Conclusions Clinically significant dysrhythmias were uncommon in young adult patients after cAVSD repair. However, three patients required pacemaker implantation for either progression of SND or spontaneous type II second‐degree AVB. Longer follow‐up should point out whether dysrhythmias will progress or become more prevalent with increasing age.
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Affiliation(s)
- Charlotte A Houck
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Reinder Evertz
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christophe P Teuwen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Janneke A E Kammeraad
- Department of Pediatric Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Natasja M S de Groot
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Al Haddad E, LaPar DJ, Dayton J, Stephens EH, Bacha E. Complete atrioventricular canal repair with a decellularized porcine small intestinal submucosa patch. CONGENIT HEART DIS 2018; 13:997-1004. [DOI: 10.1111/chd.12666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/01/2018] [Accepted: 08/07/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Eliana Al Haddad
- Pediatric Cardiac Surgery, Department of Surgery; Morgan Stanley Children’s Hospital; Columbia University Medical Center; New York New York
| | - Damien J. LaPar
- Pediatric Cardiac Surgery, Department of Surgery; Morgan Stanley Children’s Hospital; Columbia University Medical Center; New York New York
| | - Jeffrey Dayton
- Division of Pediatric Cardiology; NewYork-Presbyterian/Weill Cornell Medical Center; New York New York
| | - Elizabeth H. Stephens
- Pediatric Cardiac Surgery, Department of Surgery; Morgan Stanley Children’s Hospital; Columbia University Medical Center; New York New York
| | - Emile Bacha
- Pediatric Cardiac Surgery, Department of Surgery; Morgan Stanley Children’s Hospital; Columbia University Medical Center; New York New York
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Vida VL, Tessari C, Castaldi B, Padalino MA, Milanesi O, Gregori D, Stellin G. Early Correction of Common Atrioventricular Septal Defects: A Single-Center 20-Year Experience. Ann Thorac Surg 2016; 102:2044-2051. [DOI: 10.1016/j.athoracsur.2016.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/21/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
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Kozak MF, Kozak ACLFBM, Marchi CHD, Sobrinho Junior SH, Croti UA, Moscardini AC. Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of complete atrioventricular septal defect. Braz J Cardiovasc Surg 2015; 30:304-10. [PMID: 26313720 PMCID: PMC4541776 DOI: 10.5935/1678-9741.20150036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/25/2015] [Indexed: 11/20/2022] Open
Abstract
Introduction Left atrioventricular valve regurgitation is the most concerning residual lesion
after surgical correction of atrioventricular septal defects. Objective To determine factors associated with moderate or severe left atrioventricular
valve regurgitation within 30 days of surgical repair of complete atrioventricular
septal defect. Methods We assessed the results of 53 consecutive patients 3 years-old and younger
presenting with complete atrioventricular septal defect that were operated on at
our practice between 2002 and 2010. The following variables were considered: age,
weight, absence of Down syndrome, grade of preoperative atrioventricular valve
regurgitation, abnormalities on the left atrioventricular valve and the use of
annuloplasty. Median age was 6.7 months; median weight was 5.3 Kg; 86.8% had Down
syndrome. At the time of preoperative evaluation, there were 26 cases with
moderate or severe left atrioventricular valve regurgitation (49.1%).
Abnormalities on the left atrioventricular valve were found in 11.3%; annuloplasty
was performed in 34% of the patients. Results At the time of postoperative evaluation, there were 21 cases with moderate or
severe left atrioventricular valve regurgitation (39.6%). After performing a
multivariate analysis, the only significant factor associated with moderate or
severe left atrioventricular valve regurgitation was the absence of Down syndrome
(P=0.03). Conclusion Absence of Down syndrome was associated with moderate or severe postoperative left
atrioventricular valve regurgitation after surgical repair of complete
atrioventricular septal defect at our practice.
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Affiliation(s)
- Marcelo Felipe Kozak
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
| | | | - Carlos Henrique De Marchi
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
| | - Sirio Hassem Sobrinho Junior
- Department of Cardiology, Hospital de Base, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
| | - Ulisses Alexandre Croti
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
| | - Airton Camacho Moscardini
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
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Stephens EH, Ibrahimiye AN, Yerebakan H, Yilmaz B, Chelliah A, Levasseur S, Mosca RS, Chen JM, Chai P, Quaegebeur J, Bacha EA. Early Complete Atrioventricular Canal Repair Yields Outcomes Equivalent to Late Repair. Ann Thorac Surg 2015; 99:2109-15; discussion 2115-6. [DOI: 10.1016/j.athoracsur.2015.01.063] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/19/2015] [Accepted: 01/27/2015] [Indexed: 11/30/2022]
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Colen T, Smallhorn JF. Three-dimensional echocardiography for the assessment of atrioventricular valves in congenital heart disease: past, present and future. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2015; 18:62-71. [PMID: 25939845 DOI: 10.1053/j.pcsu.2015.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 01/12/2015] [Accepted: 01/12/2015] [Indexed: 11/11/2022]
Abstract
Echocardiography has developed as an imaging technology over 60 years to become the mainstay for investigating heart disease, providing invaluable structural and functional information. In the last 20 years, 3-dimensional echocardiography (3DE) has emerged as an adjunct to 2-dimensional echocardiography in adult and congenital heart disease. Early work with 3-dimensional imaging of the mitral valve describing normal annular shape and function significantly changed the understanding of mitral valve dynamics. Further work led to our current understanding of the mitral valve working as a unit, with all components vital to its normal function. With improving technology and ease of use, similar 3DE techniques have been used in congenital heart disease to study the unique anatomy and function of atrioventricular (AV) valves, specifically the tricuspid valve in hypoplastic left heart syndrome, and the left AV valve in atrioventricular septal defects. This paper describes the role of 3DE in assessing AV valve function in normal valves, and in congenital heart disease.
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Affiliation(s)
- Timothy Colen
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Jeffrey F Smallhorn
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, and Stollery Children's Hospital, Edmonton, Alberta, Canada.
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Prifti E, Bonacchi M, Baboci A, Giunti G, Krakulli K, Vanini V. Surgical outcome of reoperation due to left atrioventricular valve regurgitation after previous correction of complete atrioventricular septal defect. J Card Surg 2014; 28:756-63. [PMID: 24224745 DOI: 10.1111/jocs.12231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aims of this study were to evaluate the early and late outcomes in patients undergoing reoperation due to left atrioventricular valve regurgitation (LAVVR) after initial complete repair (ICR) of complete atrioventricular septal defect (CAVSD). MATERIALS AND METHOD Between January 1990 and April 2013, 45 consecutive patients underwent reoperation due to severe LAVVR. The mean age was 7.5 ± 6.2 years. Associated LAVV malformations were found in 22 (49%) patients and associated cardiac malformations in 18 (40%). The mean follow-up was 6.8 ± 2.6 years. RESULTS LAVV repair was possible in all patients. There were two hospital deaths (4.5%). Ten patients (22%) required a second reoperation due to severe LAVVR at mean 7.5 ± 8.4 months after the first reoperation. The actuarial overall survival and free-reoperation survival rates at one, three, and five years were 95.4%, 92.8%, and 92.8% and 89%, 80.5%, and 72%, respectively. Multivariate analysis revealed that the associated cardiac malformations, LAVV leaflet prolapse or detachment from the septal patch, associated LAVV malformations, and post-first correction LAVVR grade ≥ 2 were strong predictors for poor overall free-reoperation survival in patients undergoing reoperation due to LAVVR after ICR of various forms of ACVSD. CONCLUSIONS Patients with severe LAVVR post-ICR of CAVSD may undergo reoperation with acceptable postoperative mortality and morbidity; however, they are at an increased risk for developing postoperative LAVVR and subsequent reoperation.
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Affiliation(s)
- Edvin Prifti
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
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Deraz S, Ismail M. Single patch technique versus double patch technique in repair of complete atrioventricular septal defect. Egypt Heart J 2014. [DOI: 10.1016/j.ehj.2013.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Comparison of two surgical techniques for complete atrioventricular septal defect repair using two- and three-dimensional echocardiography. Pediatr Cardiol 2014; 35:393-8. [PMID: 24022512 DOI: 10.1007/s00246-013-0790-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
Abstract
Different surgical techniques for complete atrioventricular septal defect (CAVSD) repair have been described, with the double-patch technique being most frequently employed. More recently a newer technique using a modified single-patch repair has been advocated. We hypothesized that the modified single-patch technique would result in an increased incidence of the two major post-repair comorbidities, namely, distortion of the left AV valve (LAVV) leaflets and narrowing of the left-ventricular outflow tract (LVOT). We studied 14 patients with CAVSD who underwent either traditional double-patch technique [group 1 (n = 7)] or modified single-patch technique [group 2 (n = 7)]. Preoperative and immediate postoperative two-dimensional (2D) echocardiograms, as well as follow-up 2D and three-dimensional (3D) studies, were reviewed. For group 1, the median age at repair was 4.1 months with a median duration from surgical repair and last echocardiogram of 44 months. For group 2, the median age at repair was 3 months with a median duration from surgical repair and last echocardiogram of 28 months. The two groups had similar demographics and ventricular septal defect size before surgery. For the LAVV, no significant difference was observed with respect to LAVV annulus size, tenting height, and the size of the vena contracta. Furthermore, there was no significant difference in the 2D echocardiographic areas and volumes of the LVOT between pre-repair and immediate post-repair studies for both groups. At the last evaluation, although there had been growth of the LVOT in both groups, no significant difference between areas and volumes were observed. Areas of the LVOT measured by 3D echocardiography on the final study showed no significant statistical difference between both groups. There was good correlation of the areas measured by 2D and 3D echocardiography within each group. In this small group, modified single-patch technique does not appear to tether the LAVV or promote an increase in regurgitation. In the short term, LVOT growth is unaffected, and the repair does not promote LVOT obstruction. 3D echocardiography is useful for area measurements of the LVOT and showed good correlation with areas measured by assumption of the LVOT shape as determined using 2D techniques.
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Xie O, Brizard CP, d'Udekem Y, Galati JC, Kelly A, Yong MS, Weintraub RG, Konstantinov IE. Outcomes of repair of complete atrioventricular septal defect in the current era. Eur J Cardiothorac Surg 2013; 45:610-7. [PMID: 24057432 DOI: 10.1093/ejcts/ezt444] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We sought to evaluate the surgical outcomes of the repair of complete atrioventricular septal defects (cAVSDs) in our institution in the current era. METHODS From 2000 to 2011, 138 patients underwent definitive repair of cAVSD. Repair was performed using a two-patch technique in 92.0% of patients and one-patch technique in 2.2%, and the ventricular septal component was closed directly in 5.8% of patients. RESULTS Operative mortality was 1.4% (2 of 138). Overall mortality was 5.8% (8 of 138). Follow-up was 96% complete. Freedom from reoperation was 84.3% (95% CI 77.1-91.5%) at 8 years. Age >6 months at repair was associated with higher rates of reoperation (P = 0.001; HR 6.85; 95% CI 2.30-20.44). However, operating at <6 months of age was associated with longer intensive care unit stay (P = 0.019; median 2.7 vs 1.4 days), mechanical ventilation (P = 0.001; median 1.7 vs 0.9 days) and postoperative hospital stay (P = 0.016; median 8 vs 5 days). Moderate or greater left atrioventricular valvular regurgitation (LAVVR) at discharge was a risk factor for reoperation (P < 0.001; HR 10.85; 95% CI 3.75-31.40). CONCLUSIONS Repair of cAVSD carries low mortality, but a moderate reoperation rate. An optimal time for repair of the cAVSD is between 3 and 6 months of age. Repair prior to 3 months of age and the need for cleft closure were associated with a higher degree of LAVVR at discharge. Greater LAVVR at discharge is a risk factor for reoperation regardless of age at initial repair. In the current era, Down's syndrome is not a risk factor for reoperation.
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Affiliation(s)
- Ouli Xie
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
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13
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Hoohenkerk GJF, Bruggemans EF, Koolbergen DR, Rijlaarsdam MEB, Hazekamp MG. Long-term results of reoperation for left atrioventricular valve regurgitation after correction of atrioventricular septal defects. Ann Thorac Surg 2012; 93:849-55. [PMID: 22265201 DOI: 10.1016/j.athoracsur.2011.09.043] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 09/07/2011] [Accepted: 09/14/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Long-term results of reoperation for left atrioventricular valve regurgitation (LAVVR) after previous correction of atrioventricular septal defect (AVSD) are scarce. We evaluated long-term outcome of reoperation for LAVVR and identified risk factors for reoperation. METHODS Between December 1976 and July 2006, 45 of 312 patients with correction of different AVSDs underwent reoperation for LAVVR. The cohort of 267 patients who did not need reoperation for LAVVR allowed for the identification of risk factors for reoperation and evaluation of overall survival after primary AVSD repair in a competing risk scenario. Clinical data were obtained by retrospective review. RESULTS The left atrioventricular valve (LAVV) was repaired in 31 patients (68.9%) and replaced in 14 (31.1%). There were 3 in-hospital deaths (6.7%) and 2 late deaths (4.4%). Estimated overall survival was 88.1% at 15 years after the reoperation, and estimated incidence of death after reoperation in the total patient cohort was 2% at 15 years after the primary AVSD repair. Overall survival was significantly higher after LAVV repair than after replacement (p=0.010). Ten patients with LAVV repair required a second reoperation for LAVVR. At follow-up, survivors were in New York Heart Association functional class I (n=36) or II (n=4). Independent risk factors for first reoperation for LAVVR were associated cardiovascular anomalies (p<0.001), LAVV dysplasia (p<0.001), and nonclosure of the cleft (p=0.027). CONCLUSIONS After previous correction of AVSD, LAVVR can usually be corrected by valve repair. A very dysplastic valve may necessitate replacement. Overall survival is higher after repair than after replacement. In general, overall survival of patients reoperated on for LAVVR is favorable. The overall mortality rate after primary repair of AVSD is explained only for a small part by mortality after reoperation for LAVVR.
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Affiliation(s)
- Gerard J F Hoohenkerk
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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Yamano S, Uechi M, Tanaka K, Hori Y, Ebisawa T, Harada K, Mizukoshi T. Surgical Repair of a Complete Endocardial Cushion Defect in a Dog. Vet Surg 2011; 40:408-12. [DOI: 10.1111/j.1532-950x.2011.00797.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Ando M, Takahashi Y. Variations of Atrioventricular Septal Defects Predisposing to Regurgitation and Stenosis. Ann Thorac Surg 2010; 90:614-21. [DOI: 10.1016/j.athoracsur.2010.03.098] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 03/08/2010] [Accepted: 03/11/2010] [Indexed: 11/25/2022]
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16
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Bakhtiary F, Takacs J, Cho MY, Razek V, Dähnert I, Doenst T, Walther T, Borger MA, Mohr FW, Kostelka M. Long-Term Results After Repair of Complete Atrioventricular Septal Defect With Two-patch Technique. Ann Thorac Surg 2010; 89:1239-43. [DOI: 10.1016/j.athoracsur.2009.11.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 11/02/2009] [Accepted: 11/03/2009] [Indexed: 11/26/2022]
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Ono M, Goerler H, Boethig D, Bertram H, Westhoff‐Bleck M, Haverich A, Breymann T. Improved Results after Repair of Complete Atrioventricular Septal Defect. J Card Surg 2009; 24:732-7. [DOI: 10.1111/j.1540-8191.2009.00912.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Masamichi Ono
- Division of Cardiothoracic, Transplantation, and Vascular Surgery
| | - Heidi Goerler
- Division of Cardiothoracic, Transplantation, and Vascular Surgery
| | - Dietmar Boethig
- Department of Pediatric Cardiology and Intensive Care Medicine
| | - Harald Bertram
- Department of Pediatric Cardiology and Intensive Care Medicine
| | | | - Axel Haverich
- Division of Cardiothoracic, Transplantation, and Vascular Surgery
| | - Thomas Breymann
- Division of Cardiothoracic, Transplantation, and Vascular Surgery
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Surgical correction for patients with tetralogy of Fallot and common atrioventricular junction. Cardiol Young 2008; 18 Suppl 3:29-38. [PMID: 19094377 DOI: 10.1017/s1047951108003272] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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19
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Gaca AM, Jaggers JJ, Dudley LT, Bisset GS. Repair of Congenital Heart Disease: A Primer—Part 2. Radiology 2008; 248:44-60. [DOI: 10.1148/radiol.2481070166] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hoohenkerk GJF, Schoof PH, Bruggemans EF, Rijlaarsdam M, Hazekamp MG. 28 years' experience with transatrial-transpulmonary repair of atrioventricular septal defect with tetralogy of Fallot. Ann Thorac Surg 2008; 85:1686-9. [PMID: 18442566 DOI: 10.1016/j.athoracsur.2007.11.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 11/09/2007] [Accepted: 11/09/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND The outcome of surgical correction of atrioventricular septal defect and tetralogy of Fallot has improved in recent years but is still reported to be associated with high mortality. Controversy exists about the need of a right ventriculotomy or a right ventricular to pulmonary artery conduit. The purpose of this study was to evaluate our results of atrioventricular septal defect and tetralogy of Fallot repair by transatrial-transpulmonary approaches. METHODS Between 1979 and 2007, 20 consecutive patients underwent correction of atrioventricular septal defect and tetralogy of Fallot. Five patients had undergone prior palliative shunts. In all patients, a transatrial-transpulmonary approach was used and repair was accomplished without a conduit. The two-patch technique was used to correct the atrioventricular septal defect. Clinical data were obtained by retrospective review of inpatient and outpatient clinical charts. RESULTS There was no in-hospital mortality and one late, noncardiac death. Six patients required eight reoperations, six for left atrioventricular valve insufficiency (repair: n = 4; replacement: n = 2), one for residual ventricular septal defect, and one for pulmonary artery branch obstruction. Follow-up was complete for all patients (median, 17 years; range, 1.5 to 28 years). All 19 survivors were in good clinical condition at last control, without medication, and in New York Heart Association class I (n = 18) or II (n = 1). Transesophageal echocardiography revealed good right ventricular function, low right ventricular outflow tract gradients (mean, 9 +/- 7.4 mm Hg), and trace pulmonary valve insufficiency (n = 11). CONCLUSIONS Atrioventricular septal defect and tetralogy of Fallot can be repaired with low mortality by the transatrial-transpulmonary approach without the use of a conduit.
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Affiliation(s)
- Gerard J F Hoohenkerk
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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21
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Rasiah SV, Ewer AK, Miller P, Wright JG, Tonks A, Kilby MD. Outcome following prenatal diagnosis of complete atrioventricular septal defect. Prenat Diagn 2008; 28:95-101. [DOI: 10.1002/pd.1922] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Litwin SB, Tweddell JS, Mitchell ME, Mussatto KA. The double patch repair for complete atrioventricularis communis. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2007:21-7. [PMID: 17433987 DOI: 10.1053/j.pcsu.2007.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
This article is a review of our experience with the two-patch repair of complete atrioventricularis communis. From October 1988 through December 2005, 222 infants and children underwent surgery. There were six early (2.7%) and six late (2.7%) deaths. Reoperation was required in 22 patients (10%) for residual or recurrent mitral regurgitation or stenosis, subaortic stenosis, repair of a ventricular septal defect with or without pulmonary stenosis, placement of a right heart valved conduit, and/or placement of a permanent cardiac pacemaker. All patients survived second operations and no child required early or late mitral valve replacement. The two-patch repair is a reliable surgical technique resulting in low mortality and a low need for reoperation.
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Affiliation(s)
- S Bert Litwin
- Department of Cardiothoracic Surgery, Herma Heart Center, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
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23
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Takahashi K, Guerra V, Roman KS, Nii M, Redington A, Smallhorn JF. Three-dimensional Echocardiography Improves the Understanding of the Mechanisms and Site of Left Atrioventricular Valve Regurgitation in Atrioventricular Septal Defect. J Am Soc Echocardiogr 2006; 19:1502-10. [PMID: 17138036 DOI: 10.1016/j.echo.2006.07.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this study was to determine whether 3-dimensional echocardiography (3DE) provides additional information regarding the mechanisms and sites of left atrioventricular valve regurgitation in atrioventricular septal defect compared with transesophageal 2-dimensional echocardiography (2DE). METHODS Eleven patients with a median age of 5.4 years (2.9-11.6 years) and a median weight of 16.8 kg (13.7-38.3 kg) with an atrioventricular septal defect underwent simultaneous transesophageal 2DE and 3DE before operation. RESULTS The 2DE-3DE agreement for the assessment of the superior and mural leaflet size was 72.7%. The 2DE-3DE agreement for coaptation failure, a residual or primary cleft, and commissural abnormalities as a mechanism of regurgitation were 72.7%, 63.6%, and 36.4%, respectively. For jet sites the 2DE-3DE agreement was 63.6% for a commissural and central location. CONCLUSION Three-dimensional echocardiography provides new and superior data regarding the mechanisms and sites of left atrioventricular valve regurgitation in atrioventricular septal defect.
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Affiliation(s)
- Ken Takahashi
- Division of Cardiology and the Department of Pediatrics, The Hospital for Sick Children, The University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
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Ten Harkel ADJ, Cromme-Dijkhuis AH, Heinerman BCC, Hop WC, Bogers AJJC. Development of left atrioventricular valve regurgitation after correction of atrioventricular septal defect. Ann Thorac Surg 2005; 79:607-12. [PMID: 15680844 DOI: 10.1016/j.athoracsur.2004.07.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Left-sided atrioventricular valve regurgitation is the main indication for reoperation in patients after repair of both partial and complete atrioventricular septal defect. Until now, the timing for reoperation is difficult. We sought to determine the outcome of severe residual left-sided atrioventricular valve regurgitation, either medically treated or reoperation. In this regard risk factors were determined for severe residual left-sided atrioventricular valve regurgitation and reoperation, and the most appropriate strategy for patients with postoperative severe left-sided atrioventricular valve regurgitation was identified. METHODS Retrospective review of clinical, operative, and echocardiographic data was performed. From 1990 until 2001 164 patients underwent correction of their atrioventricular septal defect. RESULTS Five patients died in the immediate postoperative period, and 2 patients were lost to follow-up. During follow-up (median, 66 months; range, 9 months to 12 years), 30 patients (19%) had severe left-sided atrioventricular valve regurgitation. Sixteen patients had severe left-sided atrioventricular valve regurgitation in the immediate postoperative period; 4 of them showed spontaneous regression to near-normal valve function during follow-up. Fourteen patients exhibited left-sided atrioventricular valve regurgitation during follow-up; 8 of them remained stable with medication only. Fifteen of the 30 patients with severe left-sided atrioventricular valve regurgitation underwent reoperation. A significant risk factor for the development of severe left-sided atrioventricular valve regurgitation and reoperation was the presence of preoperative severe left-sided atrioventricular valve regurgitation. CONCLUSIONS Severe left-sided atrioventricular valve regurgitation develops in a significant number of patients after correction of atrioventricular septal defect, and preoperative severe left-sided atrioventricular valve regurgitation is an important risk factor. Although reoperation usually results in good valve function, spontaneous regression after the immediate postoperative period is possible and should be given a fair chance.
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Prifti E, Bonacchi M, Bernabei M, Crucean A, Murzi B, Bartolozzi F, Luisi VS, Leacche M, Vanini V. Repair of complete atrioventricular septal defects in patients weighing less than 5 kg. Ann Thorac Surg 2004; 77:1717-26. [PMID: 15111173 DOI: 10.1016/j.athoracsur.2003.06.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of weight less than 5 kg at operation on mortality and morbidity in patients with atrioventricular septal defect (AVSDc) undergoing total correction. METHODS Between January 1990 and December 2002, 190 consecutive patients with AVSDc underwent total biventricular correction. They were divided into two groups: group I (n = 64 patients weighing < 5 kg) and group II (n = 126 patients weighing > 5 kg). Associated major cardiac malformations were found in 49 (25.8%) patients. Associated left atrioventricular valve (LAVV) malformations were found in 35 (18.4%) patients. The mean follow-up time was 4.1 +/- 2.9 years (range 2 months-10.7 years). RESULTS The in-hospital mortality in group I was 7.8% (5 patients) versus 8.7% (11 patients) in group II (p = 0.95). Major associated cardiac malformations (p < 0.001) and pulmonary hypertension (p = 0.006) were found to be strong predictors for poor postoperative survival. At discharge the mean LAVVR grade in group I was 1.45 +/- 1.2 versus 1.2 +/- 1 in group II (p = 0.13). The actuarial overall survival rates at 1, 3, 5, and 7 years were 96.5%, 92.5%, 91.5%, and 89% respectively and the actuarial overall reoperation free survival rates at 1, 3, 5, and 7 years were 95%, 87%, 84%, and 73%. Twenty-three patients underwent reoperation due to severe left atrioventricular valve regurgitation (LAVVR). Strong predictors for overall reoperation free survival were the operation year before 1995 (p < 0.001), postoperative LAVVR greater than or equal to 2 (p = 0.006), major associated cardiac malformations (p = 0.00034), associated LAVV malformations (p = 0.0044), and non or partial LAVV cleft closure (p = 0.012). The actuarial survival rates between patients weighing less than 5 kg versus patients weighing more than 5 kg were similar (p = 0.51); instead the overall reoperation free survival was significantly lower in patients weighing less than 5 kg (p = 0.022) according to the log-rank test. Weight less than 5 kg (p = 0.023, beta = -0.6) was one of the predictors for reoperation due to severe LAVVR in this series. CONCLUSIONS We may conclude that in the current era repair of AVSDc can be carried out successfully in patients less than 5 kg, however, weight less than 5 kg at initial complete repair seems to be a predictor for late reoperation due to LAVVR. Suture separation at the cleft site or between the leaflets of the newly created mitral valve and the patch remain the main causes of postoperative LAVVR in patients weighing less than 5 kg.
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Affiliation(s)
- Edvin Prifti
- Division of Pediatric Cardiac Surgery, G. Pasquinucci Hospital, Massa, Italy
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Prifti E, Bonacchi M, Bernabei M, Leacche M, Bartolozzi F, Murzi B, Battaglia F, Nadia NS, Vanini V. Repair of Complete Atrioventricular Septal Defect with Tetralogy of Fallot:. J Card Surg 2004; 19:175-83. [PMID: 15016061 DOI: 10.1111/j.0886-0440.2004.04031.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this report is to describe the rationale of our surgical approach, to explore the best management for complete atrioventricular septal defect associated with the tetralogy of Fallot (CAVSD-TOF), and to present our outcome in relation to the previously reported series. MATERIALS AND METHODS Between January 1990 and January 2002, 17 consecutive children with CAVSD-TOF underwent complete correction. Nine patients (53%) underwent previous palliation. Mean age at repair was 2.9 +/- 1.9 years. Mean gradient across the right ventricular outflow tract was 63 +/- 16 mmHg. All children underwent closure of septal defect with a one-patch technique, employing autologous pericardial patch. Maximal tissue was preserved for LAVV reconstruction by making these incisions along the RV aspect of the ventricular septal crest. LAVV annuloplasty was performed in 10 (59%) patients. Six patients (35%) required a transannular patch. RESULTS Three (17.6%) hospital deaths occurred in this series. Causes of death included progressive heart failure in two patients and multiple organ failure in the other patient. Two patients required mediastinal exploration due to significant bleeding. Dysrhythmias were identified in 4 of 11 patients undergoing a right ventriculotomy versus none of the patients undergoing a transatrial transpulmonary approach (p = ns). The mean intensive care unit stay was 3.2 +/- 2.4 days. Two patients required late reoperation due to severe LAVV regurgitation at 8.5 and 21 months, respectively, after the intracardiac complete repair. The mean follow-up time was 36 +/- 34 months. All patients survived and are in NYHA functional class I or II. The LAVV regurgitation grade at follow-up was significantly lower than soon after operation, 1.1 +/- 0.4 versus 1.7 +/- 0.5 (p = 0.002). At follow-up, the mean gradient across the right ventricular outflow tract was 17 +/- 6 mmHg, significantly lower than preoperatively (p < 0.001). CONCLUSIONS Complete repair in patients with CAVSD-TOF seems to offer acceptable early and mid-term outcome in terms of mortality, morbidity, and reoperation rate. Palliation prior to complete repair may be reserved in specific cases presenting small pulmonary arteries or severely cyanotic neonates. The RVOT should be managed in the same fashion as for isolated TOF; however, a transatrial transpulmonary approach is our approach of choice.
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Affiliation(s)
- Edvin Prifti
- Department of Pediatric Cardiac Surgery, G. Pasquinucci Hospital, Massa, Italy
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Fortuna RS, Ashburn DA, Carias De Oliveira N, Burkhart HM, Konstantinov IE, Coles JG, Smallhorn JF, Williams WG, Van Arsdell GS. Atrioventricular septal defects: effect of bridging leaflet division on early valve function. Ann Thorac Surg 2004; 77:895-902; discussion 902. [PMID: 14992894 DOI: 10.1016/s0003-4975(03)01066-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bridging leaflet division may facilitate repair of atrioventricular septal defects (AVSD). However, the consequences of bridging leaflet division on early valve function and mortality are not well defined. METHODS Records of children undergoing AVSD repair between January 1995 and January 2002 were reviewed. Multivariable analysis defined risk factors for moderate or greater atrioventricular valve regurgitation (AVVR) and death/reoperation within 1 year of repair. RESULTS A total of 209 children (median age 5 months, median weight 5 kg) had defects whose repair included the possibility of bridging leaflet division. Bridging leaflets divided were both (n = 119, 58%), one (n = 30, 15%), or none (n = 55, 27%). Freedom from AVVR (moderate or greater) is 84%, 80%, and 78% at 1, 6, and 12 months. Risk factors include technical factors: number of bridging leaflets divided, longer cross-clamp time, and right-sided annuloplasty. Other risk factors include preoperative AVVR (moderate or greater), double-orifice or parachute left AV valve, and younger age. Freedom from death/reoperation for AVVR is 96%, 92%, and 90% at 1, 6, and 12 months. Risk factors are preoperative AVVR (moderate or greater) and parachute left AV valve. Findings at reoperation (n = 15, 7.2%) were cleft dehiscence or tear along cleft closure (n = 10), dehiscence of divided leaflet from septation patch (n = 1), or other (n = 4). Operative mortality (n = 6, 2.9%) included failed reoperations for AVVR (n = 4), dehiscence of divided leaflet from septation patch (n = 1), and sepsis (n = 1). CONCLUSIONS Division of bridging leaflets is a risk factor for AVVR (moderate or greater) during the first year after repair. Preservation of bridging leaflet integrity may improve valve competency, decrease the need for future reoperation, and eliminate some causes of operative mortality.
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Affiliation(s)
- Randall S Fortuna
- Department of Surgery, Division of Cardiovascular Surgery, Hospital for Sick Children, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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Chikada M, Sekiguchi A, Miyamoto T, Matsuzaki M, Ishida R, Ishizawa A. Direct closure of ostium primum defect in the repair of atrioventricular septal defect. Ann Thorac Surg 2001; 72:430-2; discussion 432-3. [PMID: 11515878 DOI: 10.1016/s0003-4975(01)02809-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patch closure is generally performed for atrial septation of an atrioventricular septal defect. We recently developed a new surgical technique for repairing atrioventricular septal defects that avoids the use of any patch material for closing the atrial septal defect. We report our experience with this procedure. METHODS Seven patients (complete type: 5, partial type: 2) underwent this new operation. The diameters of the atrial septal defects were measured by transesophageal echocardiography. The preoperative electrocardiograms were compared with those taken after the operations. RESULTS Diameters of the atrial defects ranged from 3 to 10 mm. Electrocardiograms before and after the operations did not change. No significant atrioventricular valve regurgitation and no residual shunts were detected by postoperative echocardiography. CONCLUSIONS This method simplifies the repair of atrioventricular septal defects. In the short-term results, no arrhythmia and no valve regurgitation was seen.
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Affiliation(s)
- M Chikada
- Division of Cardiovascular Surgery, National Children's Hospital, Tokyo, Japan.
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