PMCID: PMC2900854 DOI: 10.1016/j.athoracsur.2009.10.047
BACKGROUND: Surgical and perioperative improvements permit earlier repair of partial and transitional atrioventricular septal defects (AVSD). We sought to describe contemporary outcomes in a multicenter cohort.
METHODS: We studied 87 patients undergoing primary biventricular repair of partial or transitional AVSD between June 2004 and February 2006 across seven North American centers. One-month and 6-month postoperative data included weight-for-age z-scores, left atrioventricular valve regurgitation (LAVVR) grade, residual shunts, and left ventricular ejection fraction. Paired methods were used to assess 6-month change.
RESULTS: Median age at surgery was 1.8 years; median weight z-score was -0.88. Median days for ventilation were 1, intensive care 2, and hospitalization 5, all independent of age, with 1 in-hospital death. At 1 month, 27% (16 of 73) had ejection fraction less than 55%; 20% (17 of 87) had significant LAVVR; 2 had residual shunts; 1 each had subaortic stenosis and LAVV stenosis. At 6 months (n = 60), there were no interim deaths, reinterventions, or new development of subaortic or LAVV stenosis. Weight z-score improved by a median 0.4 units (p < 0.001), especially for underweight children less than 18 months old. Left atrioventricular valve regurgitation occurred in 31% (change from baseline, p = 0.13), occurring more frequently in patients repaired at 4 to 7 years (p = 0.01). Three patients had ejection fraction less than 55%, and 1 had a residual atrial shunt.
CONCLUSIONS: Surgical repair for partial/transitional AVSD is associated with low morbidity and mortality, short hospital stays, and catch-up growth, particularly in underweight children repaired between 3 and 18 months of age. Left atrioventricular valve regurgitation remains the most common residual defect, occurring more frequently in children repaired after 4 years of age.
The Annals of thoracic surgery
Age Factors; Body Weight; Child; Child, Preschool; Cohort Studies; Comorbidity; Echocardiography; Female; Follow-Up Studies; Heart Defects, Congenital; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Hemodynamics; Hospital Mortality; Humans; Infant; Infant, Newborn; Length of Stay; Male; Mitral Valve Insufficiency; Postoperative Complications; Prognosis; Prospective Studies; Reoperation; Treatment Outcome; Tricuspid Valve Insufficiency
Minich, L LuAnn; Atz, Andrew M.; Colan, Steven D.; Sleeper, Lynn A.; Mital, Seema; Jaggers, James; Margossian, Renee; Prakash, Ashwin; Li, Jennifer S.; Cohen, Meryl S.; Lacro, Ronald V.; Klein, Gloria L.; Hawkins, John A.; Pediatric Heart Network Investigators; and Shirali, Girish S., "Partial and transitional atrioventricular septal defect outcomes." (2010). Manuscripts, Articles, Book Chapters and Other Papers. 949.