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Ann Thorac Surg 2001;72:1621-1629
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Surgical repair of complete atrioventricular septal defect

Fred A. Crawford, Jr, MD*a, Martha R. Stroud, MSa

a Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA

* Address reprint requests to Dr Crawford, Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, Suite 409, Charleston, South Carolina 29425, USA
e-mail: crawfrdf{at}musc.edu

Presented at the Thirty-seventh Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.

Background. The objective of this study was to assess the outcome of complete atrioventricular septal defect repair from 1981 to 2000.

Methods. One hundred seventy-two consecutive patients with atrioventricular septal defect were operated on by a single surgeon using a consistent operative technique (single patch; "cleft" closure). The patients’ age range was from 5 weeks to 9 years (mean, 10.8 ± 1.2 months).

Results. Overall operative mortality was 15 of 172 (8.7%) and this decreased significantly from 12 of 73 (16.4%) in the first decade to 3 of 99 (3.0%) in the second decade (p = 0.0021) with no operative deaths in the last 51 patients. Operative mortality was related to decade of operation (p = 0.0021) and to use of crystalloid cardioplegia (p = 0.0047) by univariate analysis, and to decade of operation (p = 0.0016) and postoperative time on ventilator (p = 0.0023) by multivariate analysis. Actuarial long-term survival including operative deaths was 79.0% ± 3.8% at 15 years. Ten of 157 (6.4%) operative survivors have undergone reoperation for late mitral regurgitation (9 mitral valve repair, 1 mitral valve replacement) with one death. Four of 8 patients surviving late mitral valve replacement have subsequently required mitral valve repair. Freedom from late reoperation for severe mitral regurgitation was 89.9% ± 3.1% at 15 years. Freedom from late reoperation for mitral regurgitation did not decrease in the second decade (84.2% ± 6.6% at 10 years) versus the first decade (94.5% ± 3.1%) (p = 0.0679).

Conclusions. Although operative mortality for repair of atrioventricular septal defect has decreased dramatically during the past decade, the incidence of late reoperation for mitral regurgitation has not improved, and better techniques to eliminate late mitral regurgitation are needed.




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