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. L., Atz, A. M., Colan, S. D., Sleeper, L. A., Mital, S., Jaggers, J., Margossian, R., Prakash, A., Li, J. S., Cohen, M. S., Lacro, R. V., Klein, G. L., Hawkins, J. A., ., Shirali, G. S. Partial and transitional atrioventricular septal defect outcomes. The Annals of thoracic surgery 89, 530-536 (2010).