Results of one-and-a-half-patch technique for repair of complete atrioventricular septal defect with a large ventricular component

Abstract

Objectives: Management of complete atrioventricular (AV) septal defect (CAVSD) with a large ventricular component (>1 cm) remains controversial. The purpose of this study was to assess the feasibility of the one-and-a-half patch technique in repairing this lesion.

Methods: This was a retrospective review of patients undergoing surgical repair of CAVSD with a large ventricular component (>1 cm). Of the 51 patients who were identified in our database (2005-13), 18 underwent the two-patch repair, 12 underwent the modified single-patch repair and 21 underwent the one-and-a-half-patch repair. The CAVSD was combined with tetralogy of Fallot (TOF) in 3 patients and with double-outlet right ventricle (DORV) and pulmonary stenosis (PS) in two individuals in the one-and-a-half-patch group.

Results: There were two hospital deaths in the two-patch group, but no deaths in the other two groups. The modified single-patch procedure was associated with the shortest myocardial ischaemic and cardiopulmonary bypass (CPB) times, the two-patch procedure was associated with the longest times and the 1.5-patch procedure times were intermediate. Median follow-up was 35 months (41.6 ± 27.2 months). There were no reoperations in the 1.5-patch group while reintervention was required for 1 patient in the two-patch group (P = 0.252) and 3 patients in the modified single-patch group (P = 0.017). The function of the reconstituted AV valves improved after operation in the 1.5-patch group. No patient in these three groups developed subsequent left ventricular outflow tract obstruction.

Conclusions: The 1.5-patch technique is an attractive clinical option. It produces acceptable mid-term results comparable with two conventional techniques in patients with similarly sized ventricular component.

Keywords: Complete atrioventricular septal defect; Congenital heart disease; Surgical repair.