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. 2025 Jan;73(S 03):e11-e20.
doi: 10.1055/a-2536-8640. Epub 2025 Mar 28.

A 27-Year Experience with Atrioventricular Septal Defect Correction

Mina Farag  1 , Mireia Isern Hacker  1 , Philippe Grieshaber  1 , Elizabeth Fonseca Escalante  1 , Matthias Karck  1 , Raoul Arnold  2 , Matthias Gorenflo  2 , Tsvetomir Loukanov  1
Affiliations

A 27-Year Experience with Atrioventricular Septal Defect Correction

Mina Farag et al. Thorac Cardiovasc Surg. 2025 Jan.

Abstract

This single-center study investigated long-term outcomes after surgical correction of atrioventricular septal defect (AVSD).A total of 248 patients underwent biventricular repair for AVSD between 1995 and 2022. A total of 208 (83.9%) patients had complete (cAVSD), 29 (11.7%) partial (pAVSD), and 11 (4.4%) transitional AVSD (tAVSD). Associated cardiovascular anomalies were present in 88 (35.5%) cases and 61 (24.6%) patients were born prematurely. Median age at repair was 7.1 for cAVSD, 23.7 for pAVSD, and 13 months for tAVSD.Overall survival or reoperation incidence did not differ significantly between AVSD types and improved significantly over surgical eras. Survival of the entire cohort was 88.3% at 10, 83.8% at 15, and 79.6% at 25 years. Prematurity (hazard ratio [HR]: 2.43, p = 0.029), low weight (<4 kg) (HR: 3.05, p = 0.028), and partial cleft closure (HR: 2.43, p = 0.037) were independent risk factors for mortality. Forty-eight patients (19.4%) underwent a total of 64 reoperations over the study period. The main indication for reoperation was left atrioventricular valve regurgitation (LAVVR) with 55/64 procedures. However, 36% of procedures were performed to address several lesions, with left ventricular outflow tract obstruction being the second most common indication. Freedom from reoperation was 78.2, 75.8, and 72.5% at 10, 15, and 25 years, respectively. The incidence of reoperation increased significantly in association with early postoperative LAVVR ≥ I-II° (HR: 2.6, 95% confidence interval [CI]: 1.4-4.7, p = 0.002) and presence of residual cardiac defects (HR: 2.0, 95% CI: 1.1-3.6, p = 0.018).While LAVVR is the main indication for reoperation, a significant proportion of procedures address additional pathologies. Premature patients and those with associated cardiovascular anomalies should receive special attention during postoperative follow-up.

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
( A ) Left: survival estimates of the entire cohort. ( B ) Right: freedom from reoperation of the entire cohort.
Fig. 2
Fig. 2
( A ) Left: Kaplan–Meier estimate for freedom from LAVV-related reoperation stratified by degree of early LAVV regurgitation: none–I° versus I–II° or more. ( B ) Right: Kaplan–Meier estimate for survival of patients with LAVV-related reoperation compared with no LAVV reoperation. LAVV, left atrioventricular valve.
Fig. 3
Fig. 3
Detailed indications for reoperation stratified by early and late reoperation; ASD, atrial septal defect; LAVV, left atrioventricular valve; LVOTO, left ventricular outflow tract obstruction; PA, pulmonary artery; RAVV, right atrioventricular valve; RV, right ventricle; RVOTO, right ventricular outflow tract obstruction; ToF, tetralogy of Fallot; VSD, ventricular septal defect.
See this image and copyright information in PMC

References

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