The Evolution of a Residual Insufficiency of the Left AV Valve after Correction of a Complete AV Canal

Objectives: This study was designed to evaluate the evolution of a residual mitral insufficiency after correction of a complete AV canal over time and the impact on repeated intervention.

Methods: We reviewed retrospectively the data of pediatric patients undergoing CAVSD repair in our institution between 01.1995 and 07.2018. Emphasis was given on a postprocedural residual insufficiency of the newly created mitral valve (left AV valve) and its evolution during the in-hospital stay, and over follow-up. An overall of 169 patients could be identified. According to the competence of the left AV valve postoperative, two groups could be identified. 127 Patients with no/trace or mild insufficiency (Group A) and 42 patients with moderate or severe insufficiency (Group B).

Result: Median age was 6.1 months (IQR: 3–72 months). Median weight was 5.2 kg (IQR: 3.9–18.5 kg). 83 patients (48.3%) were male. Associated defects were repaired in 66 patients (38, 4%). Trisomy 21 was present in 133 of 169 patients (77, 9%). Rastelli classification was type A in 68 patients (39.5%), B in 7 patients (4.1%), and C in 84 patients (56.4%). Cross-clamp time and cardiopulmonary bypass time were similar for both groups (106 vs. 116 minutes and 164 vs. 177 minutes in mean, respectively). Left AV valve status early postoperative in Group A was assessed as no/trace or mild incompetence in 43 (33.9%) patient and 84 (66.1%), respectively. In Group B, moderate or severe insufficiency was in 34 (81%) and 8 (19%) of the patients, respectively. Follow-up could be achieved in 91.1% of the patients. Mitral valve status in latest follow-up was assessed in both groups, A and B, respectively, as follows: no/trace in 50 (42.7%) vs. 5 (15.2%) patients, mild in 57 (48.7%) vs. 11 (33.3%) patients, moderate in 10 (8.6%) vs. 17 (51.5%) patients and severe in 0 patients in both groups. In-hospital mortality was 1.7% (2 patients) vs. 3% (1 patient) in the two groups. There were no late deaths. Valve-related reoperation was significantly higher in group B—4.3% (5 patients) vs. 27.3% (9 patients), respectively.

Conclusion: The overall mortality rate remained low with no patient presenting with severe insufficiency of the left AV valve at latest follow-up. However, in the second group, this could be achieved on the basis of an increased reoperation rate, while the residual incompetence of the mitral valve in the first group showed stable findings over time, with low rate of repeated procedures. Valve-related reoperations during follow-up can safely be undertaken, leading to increased valve competence.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021