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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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Schumacher K, Marin Cuartas M, Meier S, Aydin MI, Borger MA, Dähnert I, Kostelka M, Vollroth M. Long-term results following atrioventricular septal defect repair. J Cardiothorac Surg 2023; 18:250. [PMID: 37612667 PMCID: PMC10463950 DOI: 10.1186/s13019-023-02355-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Atrioventricular septal defects (AVSD) represent 4-7% of congenital cardiac malformations. Definitive early repair is favored over prior pulmonary artery banding and delayed definitive repair in many centers. The aim of this study was to analyze long-term outcomes following AVSD repair over a 21-year period. METHODS A total of 202 consecutive patients underwent surgical AVSD correction between June 1999 and December 2020. Surgery was performed using the double-patch technique. The study data were prospectively collected and retrospectively analyzed. Primary outcomes were In-hospital mortality and overall long-term freedom from reoperation. RESULTS Median age at operation was 120 days (IQR 94-150), median weight was 5.0 kg (4.2-5.3). None of the patients died within the first 30 postoperative days. In-hospital mortality was 0.5% (1/202 patients). Median follow-up was 57 months (11-121). Overall freedom from reoperation at 5, 10 and 15 years was 91.8%, 86.9% and 86.9%, respectively. CONCLUSION AVSD repair with the double-patch technique is a safe and effective procedure with good early postoperative outcomes and low long-term reoperation rates.
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Affiliation(s)
- Katja Schumacher
- Department of Cardiac Surgery, University, Leipzig Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany
| | - Mateo Marin Cuartas
- Department of Cardiac Surgery, University, Leipzig Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany
| | - Sabine Meier
- Department of Cardiac Surgery, University, Leipzig Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany
| | - Muhammed Ikbal Aydin
- Department of Cardiac Surgery, University, Leipzig Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany
| | - Michael Andrew Borger
- Department of Cardiac Surgery, University, Leipzig Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany
| | - Ingo Dähnert
- Department of Pediatric Cardiology, Leipzig Heart Center, Leipzig, Germany
| | - Martin Kostelka
- Department of Cardiac Surgery, University, Leipzig Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany
| | - Marcel Vollroth
- Department of Cardiac Surgery, University, Leipzig Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany.
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Kinami H, Morita K, Shinohara G, Uno Y. Echocardiographic Evaluation of Postoperative Coaptation Geometry of Left AV Valve in Complete Atrioventricular Septal Defect. CLINICAL MEDICINE. PEDIATRICS 2022; 16:11795565221139118. [PMCID: PMC9742689 DOI: 10.1177/11795565221139118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/28/2022] [Indexed: 12/13/2022]
Abstract
Background: We sought to determine the difference in geometric parameters in the left atrioventricular valve (LAVV) postoperative complete atrioventricular septal defect (CAVSD) compared to the normal heart, and the correlation between geometric and functional parameters for detecting the mechanism of LAVV regurgitation (LAVVR) in CAVSD. Methods: LAVV geometric parameters based on complete and acceptable quality echocardiograms of 18 patients with repaired CAVSD compared with 17 normal controls. LAVVR severity was also quantified by indexed vena contracta (I-VC) (mm) and % jet area/left atrium area (% Jet/LA), and the correlation with LAVV parameters in the CAVSD group was investigated. Results: In the CAVSD group, the posterior closing angle (Pc) was nearly the same as the anterior closing angle (Ac), yet in the normal heart, the Pc angle was double the Ac angle. The anterior opening angle (Ao) and posterior-to-anterior leaflet diameter ratio (a/p) in the CAVSD group was also significantly smaller. The CAVSD group also had a shorter indexed coaptation length (I-CL) and indexed tenting height (I-TH). Displacement length (ΔD) differed completely between the CAVSD and Normal groups, and also showed a strong positive correlation to the functional parameters of LAVVR (% Jet/LA: r = .70, P = .02; I-VC: r = .60, P = .02). Conclusions: The parameters in this study were applicable to CAVSD AV valve coaptation characteristics. We introduced 2 novel measures that may provide important insights into the differences in geometry and performance of the LAVV in repaired CAVSD as compared to normal hearts.
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Affiliation(s)
- Hiroo Kinami
- Hiroo Kinami, Department of Cardiac Surgery, Jikei University School of Medicine, 3-25-8 Nishinbashi, Minato-ku, Tokyo 105-8461, Japan.
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Fong LS, Youssef D, Ayer J, Nicholson IA, Winlaw DS, Orr Y. Correlation of ventricular septal defect height and outcomes after complete atrioventricular septal defect repair. Interact Cardiovasc Thorac Surg 2021; 34:431-437. [PMID: 34633029 PMCID: PMC8860429 DOI: 10.1093/icvts/ivab263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/14/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES There are limited data available on the height of the ventricular component of the septal deficiency (VSD) in patients undergoing complete atrioventricular septal defect (CAVSD) repair. VSD height may influence optimal choice of repair strategy with potential consequences for long-term outcomes. We aimed to measure VSD height using 2-dimensional echocardiography and review its association with postoperative outcomes. METHODS We retrospectively reviewed the preoperative echocardiograms of 45 consecutive patients who underwent CAVSD repair between May 2010 and December 2015 at a single centre. VSD height and left ventricular length on the four-chamber view were measured. Demographic details and early and late outcomes including reoperation and long-term survival were studied. RESULTS Twenty patients underwent modified single-patch repair and 25 patients underwent double-patch repair of CAVSD. VSD height in the modified single-patch group ranged from 4.2 to 11.7 mm and in the double-patch group ranged from 5.1 to 14.9 mm. Nine patients had a deep ‘scoop’ with a VSD height of >10 mm, (7 double patch, 2 modified single patch). VSD height did not correlate with a specific Rastelli classification. There was no significant difference in the VSD height (P = 0.51) or the VSD height-to-left ventricular length ratio (P = 0.43) between the 2 repair groups. There was no 30-day mortality. Eight patients required reoperation; however, VSD height was not a significant predictor of reoperation (hazard ratio 0.95, 95% confidence interval 0.69–1.33; P = 0.08). CONCLUSIONS There was no correlation between VSD height and risk of reoperation after CAVSD repair. A deep ventricular scoop is uncommon in CAVSD patients.
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Affiliation(s)
- Laura S Fong
- The University of Sydney Children's Hospital at Westmead Clinical School, Sydney, NSW, Australia.,Heart Centre for Children, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - David Youssef
- Heart Centre for Children, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Julian Ayer
- The University of Sydney Children's Hospital at Westmead Clinical School, Sydney, NSW, Australia.,Heart Centre for Children, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Ian A Nicholson
- Heart Centre for Children, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - David S Winlaw
- The University of Sydney Children's Hospital at Westmead Clinical School, Sydney, NSW, Australia.,Heart Centre for Children, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Yishay Orr
- The University of Sydney Children's Hospital at Westmead Clinical School, Sydney, NSW, Australia.,Heart Centre for Children, Children's Hospital at Westmead, Sydney, NSW, Australia
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Basgoze S, Yildiz O, Ozturk E, Onan IS. Repair of complete atrioventricular canal defects: Early and midterm results and comparison of the left anterior leaflet augmentation technique with traditional technics. J Card Surg 2021; 36:2658-2668. [PMID: 33955056 DOI: 10.1111/jocs.15602] [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: 04/02/2021] [Accepted: 04/19/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Complete atrioventricular septal defects (CAVSD) include a variable spectrum of congenital malformations with different forms of clinical findings. We examined early and midterm outcomes, the need for reoperation, postoperative residual AV valve regurgitation, and other risk factors after various CAVSD repairs. METHODS Between 2014 and 2018, we have performed 89 isolated CAVSD repairs. We retrospectively reviewed the patients' medical records. Patients were divided into three groups according to their repair techniques modified one patch repair (MP) (n = 16); two patch repair (TP) (n = 49); and left anterior leaflet augmentation (ALA) technique (n = 24). RESULTS Eighty patients (89.8%) survived hospital discharge. Early mortality rates were three (18.8%) in the group MP, five (10.2%) in the group TP, and one (4.2%) in the group ALA. Thirteen patients died during the follow-up period. Late mortality rates were three (18.8%) in the group MP, four (16.6%) in the group ALA, and six (12.2%) in the group TP. The mean follow-up time was 35.9 ± 22.97 months (range: 0.3-77 months). The morbidity and mortality results were similar between-group TP and ALA but worse in the MP group. Low body weight (<4 kg) and younger age at surgery (<4 months) were found to be risk factors on mortality by univariate and multivariate analysis. Surgical technic was not found to be an independent risk factor. CONCLUSION In our series, TP and ALA techniques had satisfactory results in early and midterm periods. Younger age and small bodyweight might increase early mortality and the need for reoperation.
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Affiliation(s)
- Serdar Basgoze
- Department of Cardiovascular Surgery, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Okan Yildiz
- Department of Pediatric Cardiovascular Surgery, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Erkut Ozturk
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ismihan Selen Onan
- Department of Pediatric Cardiovascular Surgery, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Li M, Li D. Modified Single-Patch Technique Versus Two-Patch Technique for the Repair of Complete Atrioventricular Septal Defect: An Updated Meta-Analysis. Pediatr Cardiol 2021; 42:463-464. [PMID: 33515327 DOI: 10.1007/s00246-021-02552-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/08/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Mengsi Li
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Dongxu Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan Province, 610041, People's Republic of China.
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Surgical Management for Complete Atrioventricular Septal Defects: A Systematic Review and Meta-Analysis. Pediatr Cardiol 2020; 41:1445-1457. [PMID: 32583199 DOI: 10.1007/s00246-020-02397-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
A meta-analysis is performed for a comparison of outcomes between the modified one-patch repair (MPR) and two-patch repair (TPR) for complete atrioventricular septal defects (CAVSD). Electronic databases, including PubMed, Scopus, Embase, and Cochrane Library were searched systematically for the literature which aimed mainly at comparing the therapeutic effects for CAVSD administrated by MPR and TPR. Corresponding data sets were extracted and two reviewers independently assessed the risks of bias. Meta-analysis was performed using Revman 5.3 and Stata 12.0. Fifteen studies meeting the inclusion criteria were included, involving 2076 subjects in total. It was observed that MPR was associated with shorter cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times, as compared with TPR. However, no statistical differences were found in terms of size of ventricular septal defects (VSD), reoperation, mortality, implantation of permanent pacemakers, and length of ventilation, hospital and intensive care unit stay. As compared with TPR, MPR is superior in terms of ACC and CPB. However, with regard to reoperation, mortality, length of ventilation, ICU and hospital stay and permanent pacemakers implantation, no significant differences are found between these two procedures. MPR is likely to apply to younger infants with faster completion of surgery. Surgery is recommended between 3 and 6 months of age.
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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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9
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Fong LS, Betts K, Bell D, Konstantinov IE, Nicholson IA, Winlaw DS, Orr Y, Hu T, Radford D, Alphonso N, Andrews D. Complete atrioventricular septal defect repair in Australia: Results over 25 years. J Thorac Cardiovasc Surg 2020; 159:1014-1025.e8. [DOI: 10.1016/j.jtcvs.2019.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 08/02/2019] [Accepted: 08/13/2019] [Indexed: 11/30/2022]
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Wang G, Ma K, Pang K, Hua Z, Zhang S, Qi L, Yang Y, Feng Z, Mao F, Zhang H, Li S. Modified Single Repair Technique for Complete Atrioventricular Septal Defect: A Propensity Score Matching Analysis. Pediatr Cardiol 2020; 41:615-623. [PMID: 31974717 DOI: 10.1007/s00246-020-02292-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/17/2020] [Indexed: 11/26/2022]
Abstract
There were controversies about the priority of modified single patch (MSP) technique compared with two-patch (TP) technique for patients with complete atrioventricular septal defect (CAVSD). From 2002 to 2013, patients who diagnosed as balanced CAVSD in our institution were retrospectively included. Patients with unbalanced ventricles or associated anomalies were excluded. The primary endpoint was all-cause mortality and the secondary endpoint consist of left atrioventricular dysfunction or left atrioventricular outflow tract obstruction (LVOTO). A total of 74 patients underwent MSP repair and 102 patients underwent TP repair. After 1:1 propensity matching, there were 46 Rastelli type A CAVSD patients in each group. Patients in MSP group had shorter cardiopulmonary bypass time [median (interquartile range) 73.5 (65.5-95.0) versus 105.0 (88.8-130.0) min, P < 0.001] and aortic cross-clamp time [105.5 (90.0-128.0) versus 143.0 (122.0-184.0) min, P < 0.001]. In total, the primary endpoint occurred in 12 patients, including 2/46 (4.3%) in MSP group and 10/46 (21.7%) in TP group. That 1-year, 3-year, 5-year survival rate can be calculated as 95.6%, 95.6%, 95.6% in MSP group and 92.6%, 80.4%, 78.2% in TP group, P = 0.015. No significant statistical difference found for the secondary endpoints that 7/46 (15.2%) patients occurred moderate or severe LAVVR in MSP group versus 11/46 (23.9%) patients in TP group, P = 0.293. No LVOTO occurred in both groups. Besides the simplicity of technique, MSP technique may be safer.
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Affiliation(s)
- Guanxi Wang
- Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, The People's Republic of China
| | - Kai Ma
- Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, The People's Republic of China
| | - Kunjing Pang
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, The People's Republic of China
| | - Zhongdong Hua
- Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, The People's Republic of China
| | - Sen Zhang
- Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, The People's Republic of China
| | - Lei Qi
- Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, The People's Republic of China
| | - Yang Yang
- Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, The People's Republic of China
| | - Zicong Feng
- Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, The People's Republic of China
| | | | - Hao Zhang
- Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, The People's Republic of China
| | - Shoujun Li
- Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, The People's Republic of China.
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Loomba RS, Flores S, Villarreal EG, Bronicki RA, Anderson RH. Modified Single-Patch versus Two-Patch Repair for Atrioventricular Septal Defect: A Systematic Review and Meta-Analysis. World J Pediatr Congenit Heart Surg 2020; 10:616-623. [PMID: 31496417 DOI: 10.1177/2150135119859882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We performed a meta-analysis of studies to determine whether the modified single-patch technique offers benefits when compared to the two-patch repair. The postoperative outcomes examined in this study were cardiopulmonary bypass time, cross-clamp time, duration of mechanical ventilation, intensive care unit length of stay, total hospital length of stay, need for reoperation, need for reoperation for left ventricular outflow tract obstruction or left atrioventricular valve regurgitation, need for pacemaker implantation, and mortality during follow-up. METHODS A review was conducted to identify studies comparing a modified single-patch repair versus two-patch repair. A fixed-effects model was utilized for end points with low heterogeneity and a random-effects model for end points with significant heterogeneity. Meta-regression was also performed to determine the influence of other factors on the variables of interest. RESULTS A total of 964 unique manuscripts were screened, with 10 being included in the final analyses. There were a total of 724 patients, with 353 (49%) having undergone repair utilizing a modified single-patch repair. Mean age at repair for modified single-patch repair and two-patch repair was 8.81 and 9.03 months, respectively. Significant differences were noted in cardiopulmonary bypass time and cross-clamp time with mean difference of -28.53 and -22.69 minutes, respectively. In comparison to the two-patch repair, both times were decreased in modified single-patch repair. No significant difference was noted in any other variables. CONCLUSIONS Modified single-patch repair for atrioventricular septal defects requires less cardiopulmonary bypass and cross-clamp time but does not significantly impact the examined postoperative outcomes.
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Affiliation(s)
- Rohit S Loomba
- Cardiology, Pediatrics, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Saul Flores
- Critical Care and Cardiology, Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Enrique G Villarreal
- Critical Care and Cardiology, Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Ronald A Bronicki
- Critical Care and Cardiology, Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Robert H Anderson
- Institute of Genetics, Newcastle University, Newcastle Upon Tyne, United Kingdom
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Dawary MA, Alshamdin FD, Alkhalaf LH, Alkhamis AO, Khouqeer FA. Outcomes of surgical repair of complete atrioventricular canal defect in patients younger than 2 years of age. Ann Saudi Med 2019; 39:422-425. [PMID: 31804135 PMCID: PMC6894453 DOI: 10.5144/0256-4947.2019.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Early surgical management of complete atrioventricular (AV) canal defect is the optimal treatment option. Since the published evidence on outcomes is inconclusive, we retrospectively studied the outcomes of patients in our institution. OBJECTIVE Study outcomes of complete AV canal repair. DESIGN Retrospective, descriptive. SETTINGS Single institute. PATIENTS AND METHODS Medical records of patients under 2 years of age who underwent complete AV canal repair from January 2004 to December 2014 were retrospectively reviewed. MAIN OUTCOME MEASURES Pre- and postoperative morbidity and mortality. SAMPLE SIZE 140 patients. RESULT The median (IQR) age at the time of surgery was 5.4 (3.9-8.2) months. Down syndrome was diagnosed in 98 (70%) of patients. AV valve regurgitation was found preoperatively in 129 (92%) and postoperatively in 135 (96%) patients. There was a significant association between preoperative pulmonary hypertension and the development of pulmonary hypertension in the postoperative period ( P=.04). Thirty-three patients needed reoperation. Arrhythmia was found in 19 patients, 16 of whom required pacemaker insertion. Seven patients died (5%). CONCLUSION The presence of preoperative and postoperative AV valve regurgitation was common in this cohort but did not significantly affect patient survival. Our findings suggest an acceptable outcome for repair of complete AV septal defect with few complications postoperatively. LIMITATION Retrospective in single institute. CONFLICT OF INTEREST None.
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Affiliation(s)
- Mohannad Ali Dawary
- From the Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Louai Hassan Alkhalaf
- From the Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Othman Alkhamis
- From the Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fareed Ahmed Khouqeer
- From the Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Fong LS, Betts K, Kannekanti R, Ayer J, Winlaw DS, Orr Y. Modified-Single Patch vs Double Patch Repair of Complete Atrioventricular Septal Defects. Semin Thorac Cardiovasc Surg 2019; 32:108-116. [PMID: 31306766 DOI: 10.1053/j.semtcvs.2019.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/06/2019] [Indexed: 11/12/2022]
Abstract
Biventricular repair of complete atrioventricular septal defect (CAVSD) is largely achieved using the double-patch (DP) or modified single-patch (MSP) techniques in the current era; however, long-term results following MSP repair are not well defined. We aimed to compare long-term outcomes including reoperation and mortality after CAVSD repair using DP and MSP techniques, and identify the risk factors associated with adverse outcomes. A retrospective cohort study was performed including all patients who underwent CAVSD repair using DP and MSP techniques at our institution between 17 May 1990 and 14 December 2015. Demographic details, early (≤30 days) and late (>30 days) outcomes (reoperation, mortality) were studied. Competing risks analysis with cumulative incidence function was used for survival analyses. Overall, 273 consecutive patients underwent CAVSD repair (120 DP and 153 MSP) and 41 patients required reoperation during follow-up. Competing risks analysis showed no association between repair technique and reoperation (P = 1.0) or mortality (P = 0.9). Considering competing risks due to mortality, the cumulative incidence of reoperation at 5, 10, and 15 years was 14%, 17%, and 17% for DP and 12%, 13%, and 16% for MSP, respectively. Non-Down syndrome and moderate or greater left atrioventricular valve regurgitation were predictors for reoperation. Pulmonary artery banding was predictive of mortality, though strongly associated with earlier surgical era. Median follow-up duration was 8.0 years (interquartile range 3.9-20.8) for DP and 11.6 years (interquartile range 5.4-16.1) for MSP (P = 0.4). Event-free survival is similar after DP and MSP repair of CAVSD indicating either repair technique can be safely utilized.
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Affiliation(s)
- Laura S Fong
- Discipline of Child and Adolescent Health, Faculty of Health and Medicine, The University of Sydney, Sydney, Australia; Heart Centre for Children, The Children's Hospital at Westmead, Westmead, Australia.
| | - Kim Betts
- Curtin University School of Public Health, Perth, Australia
| | - Raviteja Kannekanti
- Heart Centre for Children, The Children's Hospital at Westmead, Westmead, Australia
| | - Julian Ayer
- Discipline of Child and Adolescent Health, Faculty of Health and Medicine, The University of Sydney, Sydney, Australia; Heart Centre for Children, The Children's Hospital at Westmead, Westmead, Australia
| | - David S Winlaw
- Discipline of Child and Adolescent Health, Faculty of Health and Medicine, The University of Sydney, Sydney, Australia; Heart Centre for Children, The Children's Hospital at Westmead, Westmead, Australia
| | - Yishay Orr
- Discipline of Child and Adolescent Health, Faculty of Health and Medicine, The University of Sydney, Sydney, Australia; Heart Centre for Children, The Children's Hospital at Westmead, Westmead, Australia
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Fong LS, Winlaw DS, Orr Y. Is the modified single-patch repair superior to the double-patch repair of complete atrioventricular septal defects? Interact Cardiovasc Thorac Surg 2018; 28:427-431. [DOI: 10.1093/icvts/ivy261] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/12/2018] [Accepted: 07/28/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Laura S Fong
- The University of Sydney Children's Hospital Westmead Clinical School, Westmead NSW, Australia
- Department of Cardiothoracic Surgery, The Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - David S Winlaw
- The University of Sydney Children's Hospital Westmead Clinical School, Westmead NSW, Australia
- Department of Cardiothoracic Surgery, The Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, NSW, Australia
- Sydney Children’s Hospital Network, Sydney, NSW, Australia
| | - Yishay Orr
- The University of Sydney Children's Hospital Westmead Clinical School, Westmead NSW, Australia
- Department of Cardiothoracic Surgery, The Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, NSW, Australia
- Sydney Children’s Hospital Network, Sydney, NSW, Australia
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Geoffrion TR, Singappuli K, Murala JSK. A review of the Nunn modified single patch technique for atrioventricular septal defect repair. Transl Pediatr 2018; 7:91-103. [PMID: 29770291 PMCID: PMC5938247 DOI: 10.21037/tp.2018.02.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Atrioventricular septal defect (AVSD) is a common congenital cardiac surgical problem. Over the years, younger and smaller infants are having operations for this condition before irreversible cardio pulmonary changes occur. Traditionally a single or two patch techniques have been used to repair this defect. However, in the past two decades an innovative method of modified single patch technique popularized by Dr. Graham Nunn has gained worldwide popularity. This review discusses the origin, surgical principles, technique and outcomes of this method, popularly known as Nunn or Australian technique. Research comparing the modified single patch technique to classic single and double patch techniques has shown good preservation of atrioventricular valve function, no residual ventricular septal defect (VSDs), low incidence of left ventricular outflow obstruction, preserved conduction, easy reproducibility, and improved perioperative and long-term mortality.
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Affiliation(s)
- Tracy R Geoffrion
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kanchana Singappuli
- Department of Pediatric Cardiac Surgery, Lady Ridgeway Hospital for Children, Dr. Denister De Silva Mawatha, Colombo, Sri Lanka
| | - John S K Murala
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Li D, Fan Q, Iwase T, Hirata Y, An Q. Modified Single-Patch Technique Versus Two-Patch Technique for the Repair of Complete Atrioventricular Septal Defect: A Meta-Analysis. Pediatr Cardiol 2017; 38:1456-1464. [PMID: 28711966 DOI: 10.1007/s00246-017-1684-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/11/2017] [Indexed: 11/25/2022]
Abstract
Technical selection for surgical repair of complete atrioventricular septal defect (CAVSD) still remains controversial. This meta-analysis aimed to compare the modified single-patch (MP) technique with the two-patch (TP) technique for patients with CAVSD. Relevant studies comparing the MP technique with the TP technique were identified through a literature search using MEDLINE, EMBASE, Google Scholar, Cochrane Library, and the China National Knowledge Infrastructure databases. The variables were ventricular septal defect (VSD) size, cardiopulmonary bypass (CBP) time, aortic cross-clamp (ACC) time, intensive care unit stay, hospital stay, and other outcomes involving mortality, left ventricular outflow tract obstruction, atrioventricular valve regurgitation, residual septal shunt, atrioventricular block, and reoperation. A random-effect/fixed-effect model was used to summarize the estimates of mean difference/odds ratio with 95% confidence interval. Subgroup analysis stratified by region was performed. Fifteen publications involving 1034 patients were included. This meta-analysis demonstrated that (1) VSD size in the MP group was significantly smaller; (2) CBP time, ACC time, and hospital stay in the MP group experienced improvement; (3) Other postoperative outcomes showed no significant differences between two groups; and (4) The trends in China and other countries were close. The MP and TP techniques had comparable outcomes; however, the MP technique was performed with significantly shorter CBP and ACC times in patients with smaller VSDs. Given this limitation of data, the results of comparison of the two techniques in patients with larger VSDs remain unknown. Further studies are needed.
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Affiliation(s)
- Dongxu Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Qiang Fan
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Tomoyuki Iwase
- Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yasutaka Hirata
- Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Qi An
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Atrioventricular septal defect: From embryonic development to long-term follow-up. Int J Cardiol 2016; 202:784-95. [DOI: 10.1016/j.ijcard.2015.09.081] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/28/2015] [Accepted: 09/23/2015] [Indexed: 11/18/2022]
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El-Rassi I, Charafeddine F, Tabbakh A, Aboutaka M, Khater D, Arabi M, Bitar F. Surgical repair of complete atrioventricular defect (Nunn technique). Multimed Man Cardiothorac Surg 2015; 2015:mmv023. [PMID: 26443542 DOI: 10.1093/mmcts/mmv023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 08/09/2015] [Indexed: 06/05/2023]
Abstract
Two procedures have been traditionally used for the surgical repair of complete atrioventricular canal. The single-patch technique includes the division of valve leaflets, and the use of one patch to close the ventricular and the atrial septal defects, whereas the double-patch technique uses two separate patches, without the division of the bridging leaflets. Between 1997 and 2007, another technique emerged, the modified single-patch technique, or the 'Australian' technique, whereby the ventricular septal defect (VSD) is closed by the direct apposition of the bridging leaflets against the crest of the defect. Because of the absence of the ventricular septal patch, concerns have been raised about the possible left ventricular outflow tract obstruction (LVOTO), or atrioventricular valve (AVV) distortion, especially in case of a deep VSD, or if the defect extends superiorly. The results of the modified single-patch technique in terms of mortality, immediate and long-term AVV function and LVOTO have been similar to the standard techniques in most reports. This article will describe in detail the operative technique and review the relevant literature.
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Affiliation(s)
- Issam El-Rassi
- Cardiac Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Anas Tabbakh
- Cardiac Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammad Aboutaka
- Cardiac Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Daniele Khater
- Cardiac Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Cardiac Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Cardiac Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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