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Right arrow Congenital - cyanotic

Ann Thorac Surg 2006;82:1598-1602
© 2006 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Early Repair of Complete Atrioventricular Septal Defect is Safe and Effective

R. Ramesh Singh, MBBCh, Patrick S. Warren, MD, T. Brett Reece, MD, Peter Ellman, MD, Benjamin B. Peeler, MD, Irving L. Kron, MD*

Department of Surgery, University of Virginia, Charlottesville, Virginia

Accepted for publication May 22, 2006.

* Address correspondence to Dr Kron, Department of Surgery, University of Virginia Health System, PO Box 800679, Charlottesville, VA 22908 (Email: ajh{at}virginia.edu).

Presented at the Fifty-second Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 10–12, 2005.

BACKGROUND: Surgical repair of complete atrioventricular septal defect (CAVSD) is a well-established procedure performed on young children. Our hypothesis is that with modern techniques, the current risks of CAVSD repair in children aged younger than 3 months and in children older than 3 months are equal.

METHODS: This was a retrospective review of 65 infants and children with a mean age of 10.9 months (range, 1 month to 15.5 years) who underwent CAVSD repair from 1990 to 2004. Twenty-six repairs (40%) were done on or before 3 months of age (group A) and 39 repairs (60%) were done after 3 months of age (group B). In all patients, the ventricular septal defect was repaired with an individualized approach according to each patient's specific anatomy: direct suturing without a patch, interposition of a small pericardial patch with a running suture, or both. The atrioventricular commissure was closed with interrupted sutures, and all atrial defects were closed with a pericardial patch. Data were analyzed using the {chi}2 analysis and the Fisher exact test.

RESULTS: Three hospital deaths occurred (<30 days), 2 in group A and 1 in group B (7.7% vs 2.6%, respectively, p = 0.33). One death in group A occurred during another noncardiac surgery. Early reoperation (<1 year of initial surgery) for residual ventricular septal defect or significant mitral regurgitation, or both, occurred in 3 group A patients and in 4 group B patients (11.5% versus 10.3% respectively, p = 0.68).

CONCLUSIONS: These results suggest that repair of CAVSD defects in children 3 months of age or younger had similar outcomes compared with those who underwent surgical repair after 3 months of age.






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