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Outcomes and reoperations after total correction of complete atrio-ventricular septal defect

^a Division of Congenital Cardiovascular Surgery, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zürich, Switzerland
^b Statistical Unit, Institute for Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland
^c Divisions of Pediatric Cardiology, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zürich, Switzerland

Received 11 March 2008; received in revised form 17 June 2008; accepted 24 June 2008.

^_* Corresponding author. Tel.: +41 44 2668020; fax: +41 44 2668021. (Email: ali.dodge-khatami{at}kispi.uzh.ch).

Background: Surgical correction of complete atrio-ventricular septal defect (AVSD) achieves satisfactory results with low morbidity and mortality, but may require reoperation. Our recent operative results at mid-term were followed-up. Methods: From June 2000 to December 2007, 81 patients (Down syndrome; n = 60), median age 4.0 months (range 0.7–118.6) and weight 4.7 kg (range 2.2–33), underwent complete AVSD correction. Patch closure for the ventricular septal defect (VSD; n = 69) and atrial septal defect (ASD; n = 42) was performed with left atrio-ventricular valve (LAVV) cleft closure (n = 76) and right atrio-ventricular valve (RAVV) repair (n = 57). Mortality, morbidity, and indications for reoperation were retrospectively studied; the end point ‘time to reoperation’ was analyzed using Kaplan–Meier curves. Follow-up was complete except in two patients and spanned a median of 28 months (range 0.4–6.1 years). Results: In-hospital mortality was 3.7% (n = 3) and one late death occurred. Reoperation was required in 7/79 patients (8.9%) for LAVV insufficiency (n = 4), for a residual ASD (n = 1), for right atrio-ventricular valve insufficiency (n = 1), and for subaortic stenosis (n = 1). At last follow-up, no or only mild LAVV and RAVV insufficiency was present in 81.3% and 92.1% of patients, respectively, and 2/3 of patients were medication-free. Risk factors for reoperation were younger age (<3 months; p = 0.001) and lower weight (<4 kg; p = 0.003), and a trend towards less and later reoperations in Down syndrome (p < 0.2). Conclusions: Surgical correction of AVSD can be achieved with low mortality and need for reoperation, regardless of Down syndrome or not. Immediate postoperative moderate or more residual atrio-ventricular valve insufficiency will eventually require a reoperation, and could be anticipated in patients younger than 3 months and weighing <4 kg.

Key Words: Atrio-ventricular septal defect • Surgery • Congenital heart disease

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