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Eur J Cardiothorac Surg 2005;28:223-228
© 2005 Elsevier Science NL

Original articles

Atypical forms of isolated partial atrioventricular septal defect increase the risk of initial valve replacement and reoperation

^a Department of Cardiac and Thoracic Surgery C, Hôpital Cardiologique Louis Pradel, 28, avenue du doyen Lepine, 69677 Bron Cedex, Lyon, France
^b Department of Biostatistics-Health, UMR CNRS 5558, Lyon, France

Received 30 September 2004; received in revised form 11 April 2005; accepted 25 April 2005.

^* Corresponding author. Tel.: +33 4 72 35 74 79; fax: +33 4 72 34 18 53. (Email: stephaneaubert{at}yahoo.fr).

Abstract

Objective: We consider the short- and long-term outcomes of the repair of the isolated partial atrioventricular (AV) septal defect to determine the role played by the atypical forms on the initial AV valve replacement and on the risk of reoperation. Methods: Two hundred and eight patients underwent an operation for this malformation between 1974 and 2001. Clinical and echocardiographic examinations were performed on all patients, the AV valve regurgitation was graded from 1 to 4 and a residual interatrial shunt was sought. Median age at the intervention was 5.8 years (3 months to 67 years). Results: Median follow-up time was 7.5 years (range 0–22.6 years). The cumulative 30-day, 5- and 20-year survival rates were 96.5, 95.4 and 94.6%, respectively. AV valve replacement was associated with a high mortality (P<0.001). A reoperation was performed on 12 patients (5.7%) including six patients within less than a 30-day period, especially to repair residual AV valve regurgitation. We performed four AV valve repairs by annuloplasty and six AV valve replacements. Two patients who had initially undergone an AV valve replacement underwent a reoperation for valve thrombosis. The cumulative 30-day, 5- and 20-year rates of freedom from reoperation were 96.5, 93.6 and 83%, respectively. An atypical form was present in 24 patients (11.5%) and was a risk factor for initial AV valve replacement (P<0.001) and for reoperation (P<0.001). A complete AV block occurred in 13 patients (6.2%), all of them within a 30-day period. The AV valve replacement was a high risk factor for a complete AV block (P<0.001). At the end of our study 180 patients (96%) were in NYHA I and 8 in NYHA II. Conclusions: The morbi-mortality of the isolated partial AV septal defect is primarily perioperative and is linked with the presence of an atypical form of the lesion. This atypical form was the main reason for reoperation for AV valve regurgitation. The AV valve replacement was associated with a high mortality and with the occurrence of complete AV block. Using a standardized technique, the AV septal defect can be repaired with excellent long-term clinical and echographic results.

Key Words: Atrioventricular valve • Complete atrioventricular block • Left atrioventricular valve repair • Ostium primum • Partial atrioventricular septal defect