Surgical management of complete atrioventricular septal defect: associations with surgical technique, age, and trisomy 21.
PMCID: PMC3098918 DOI: 10.1016/j.jtcvs.2010.08.093
OBJECTIVES: We sought to evaluate the contemporary results after repair of a complete atrioventricular septal defect and to determine the factors associated with suboptimal outcomes.
METHODS: The demographic, procedural, and outcome data were obtained within 1 and 6 months after repair of a complete atrioventricular septal defect in 120 children in a multicenter observational study from June 2004 to 2006.
RESULTS: The median age at surgery was 3.7 months (range, 9 days to 1.1 years). The type of surgical repair was a single patch (18%), double patch (72%), and a single atrial septal defect patch with primary ventricular septal defect closure (10%). The incidence of residual septal defects and the degree of left atrioventricular valve regurgitation (LAVVR) did not differ by repair type. The median interval of intensive care stay were 4 days, ventilation use 2 days, and total hospitalization 8 days. All were independent of the presence of trisomy 21 (80% of the cohort). The in-hospital mortality rate was 2.5% (3/120). The overall 6-month mortality rate was 4% (5/120). The presence of associated anomalies and younger age at surgery were independently associated with a longer hospital stay. The age at repair was not associated with residual ventricular septal defect or moderate or greater LAVVR at 6 months. Moderate or greater LAVVR occurred in 22% at 6 months, and the strongest predictor for this was moderate or greater LAVVR at 1 month (odds ratio, 6.9; 95% confidence interval, 2.2-21.7; P < .001).
CONCLUSIONS: The outcomes after repair of complete atrioventricular septal defect did not differ by repair type or the presence of trisomy 21. An earlier age at surgery was associated with increased resource use but had no association with the incidence of residual ventricular septal defect or significant LAVVR.
The Journal of thoracic and cardiovascular surgery
Age Factors; Angiotensin-Converting Enzyme Inhibitors; Canada; Cardiac Surgical Procedures; Chi-Square Distribution; Child, Preschool; Critical Care; Down Syndrome; Echocardiography, Doppler, Color; Female; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Hospital Mortality; Humans; Infant; Infant, Newborn; Length of Stay; Linear Models; Logistic Models; Male; Odds Ratio; Prospective Studies; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; United States
Atz, A. M., Hawkins, J. A., Lu, M., Cohen, M. S., Colan, S. D., Jaggers, J., Lacro, R. V., McCrindle, B. W., Margossian, R., Mosca, R. S., Sleeper, L. A., Minich, L. L., ., Shirali, G. S. Surgical management of complete atrioventricular septal defect: associations with surgical technique, age, and trisomy 21. The Journal of thoracic and cardiovascular surgery 141, 1371-1379 (2011).
Cardiology Commons, Cardiovascular System Commons, Congenital, Hereditary, and Neonatal Diseases and Abnormalities Commons, Pediatrics Commons, Surgery Commons, Surgical Procedures, Operative Commons
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