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. 2024 Mar 29;38(4):ivae053.
doi: 10.1093/icvts/ivae053.

Repair of the complete atrioventricular septal defect-impact of postoperative moderate or more regurgitation

Mahmut Ozturk  1 , Aybala Tongut  1 , Vanessa Sterzbecher  1 , Manan Desai  1 , Gabriel Esmailian  1 , Soichiro Henmi  1 , Christopher Spurney  2 , Steven J Staffa  3 , Yves d'Udekem  1 , Can Yerebakan  1
Affiliations

Repair of the complete atrioventricular septal defect-impact of postoperative moderate or more regurgitation

Mahmut Ozturk et al. Interdiscip Cardiovasc Thorac Surg. .

Abstract

Objectives: To study the risk factors for mortality, moderate or more left atrioventricular valve regurgitation (LAVVR) and reoperation after the surgical repair of complete atrioventricular septal defect (cAVSD) in a single centre.

Methods: The current study is a retrospective review of patients who underwent surgical repair of cAVSD between 2000 and 2021. Patients with unbalanced ventricles not amenable to biventricular repair, double outlet right ventricle and malpositioned great arteries were excluded. The clinical predictors of outcome for end points were analysed with univariate and multivariable Cox regression analysis or Fine-Gray modelling for competing risks. Time-dependent end points were estimated using the Kaplan-Meier curve analysis and cumulative incidence curves.

Results: The median follow-up time was 2.3 years. Among 220 consecutive patients were 10 (4.6%) operative and 21 late mortalities (9.6%). A total of 26 patients were identified to have immediate postoperative moderate or more regurgitation and 10 of them ultimately died. By multivariable analysis prematurity and having more than moderate regurgitation immediately after the operation were identified as predictors of overall mortality (P = 0.003, P = 0.012). Five- and ten-year survival rates were lower for patients with immediate postoperative moderate or more LAVVR {51.9% [confidence interval (CI): 27.5-71.7%]} when compared to patients without moderate or more regurgitation [93.2% (CI: 87.1-96.4%) and 91.3% (CI: 83.6-95.5%)].

Conclusions: The patients who undergo cAVSD repair remain subjected to a heavy burden of disease related to postoperative residual LAVVR. Immediate postoperative moderate or more LAVVR contributes significantly to overall mortality. Whether a second run of bypass can decrease this observed mortality should be investigated.

Keywords: Atrioventricular septal defect; Australian single patch technique; Double patch technique; Left atrioventricular valve regurgitation.

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Figures

Figure 1:
Figure 1:
Kaplan–Meier curves depicting long-term survival for all patients (left) and the comparison of survival rates by immediate postoperative moderate or greater LAVV regurgitation (right). LAVV: left atrioventricular valve.
Figure 2:
Figure 2:
Cumulative incidence curves depicting LAVV reoperation for all patients (left) and the comparison of cumulative incidence of LAVV reoperation rates for the double patch and the Australian single patch techniques (right). LAVV: left atrioventricular valve.
Figure 3:
Figure 3:
Cumulative incidence curves depicting freedom from postoperative moderate or more LAVVR development (left) and cumulative incidence of composite end point of developing moderate or more LAVVR or LAVV reoperation for all patients (right). LAVV: left atrioventricular valve; LAVVR: Left atrioventricular valve regurgitation.
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