Influence of the Preoperative AV Valve Insufficiency and Surgical Anatomy on the Results of Single-patch Repair in Complete Atrioventricular Septal Defect

Objectives: To evaluate the influence of the preoperative AV-valve regurgitation and surgical anatomy on the results of single patch repair of complete atrioventricular septal defect (CAVSD) and identify the factors of failure (death, reoperation, severe left AV-valve regurgitation).

Methods: We reviewed retrospectively the data of pediatric patients undergoing CAVSD repair in our institution between January 1995 and December 2012. Emphasis was given on the surgical Anatomy of the defect and the preoperative competence of the common AV valve. An overall of 137 patients could be identified. Classic single patch technique was used in 116 patients and Australian technique in 21 patients. According to the competence of the AV-valve two groups could be identified: 113 patients with no or mild insufficiency (group A) and 24 patients with moderate to severe insufficiency (group B).

Results: Mean age was 13.3 months (range, 0–203 months). Mean weight was 6.5 kg. Sixty-three patients (46.6%) were male. Associated defects were repaired in 54 patients (39.4%). Trisomy 21 was present in 101 of 137 patients (73.7%). Rastelli classification was type A in 47 patients (34.4%), B in 7 patients (5.11%), and C in 83 patients (60.6%). Cross-clamp time and cardiopulmonary bypass time were almost identical for both groups (109 vs. 112 minutes and 166 vs 163 minutes in mean respectively). Left AV-valve status early postoperative in Group A was assessed as no or mild incompetence in 89 (78.8%) patients, moderate in 18 (15.9%) and severe in 6 (5.3%) patients. In Group B, respectively, 14 (58.3%), 7 (29.2%) and 3 (12.5%). Mitral valve status in latest follow up was assessed in both groups respectively as follows: no or mild insufficiency in 73 (83%) Vs 11(61.1%) patients, moderate in 14 (15.9%) vs. 7 (38.9%) patients, and severe in 1 (1.1%) vs 0 patients. The freedom from reoperation was 86.7% in Group A and 75% in Group B. In-hospital mortality was 2.7% (3 patients) vs. 0 in the two groups. Long-term survival was 100% vs 95.2%, respectively. Predictor factors for failure were previous reoperation, no trisomy 21 and Rastelli Type C.

Conclusion: The single-patch repair shows very good results in long-term follow-up. Preoperative competence of the AV-valve does not influence the results whereas previous reoperation, no trisomy 21 and Rastelli type C seem to be related with worst outcome.