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Ann Thorac Surg 2007;84:624-629
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Population-Based Perspective of Long-Term Outcomes After Surgical Repair of Partial Atrioventricular Septal Defect

^a Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, Oregon
^b Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
^c Division of Pediatric Cardiology, Oregon Health and Science University, Portland, Oregon

Accepted for publication March 26, 2007.

^_* Address correspondence to Dr Welke, Division of Cardiothoracic Surgery L353, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239–3098 (Email: welkek{at}ohsu.edu).

Presented at the Fifty-third Annual Meeting of the Southern Thoracic Surgical Association, Tucson, AZ, Nov 8–11, 2006.

Background: This investigation was designed to determine long-term survival, reoperation rates, and functional status after surgical repair of partial atrioventricular septal defect (PAVSD).

Methods: This population-based cohort study with cumulative, prospective follow-up by questionnaire and medical record review included all patients aged younger than 19 years old in the state of Oregon who underwent surgical repair of a PAVSD from 1958 to 2000. The incidence of early death, late death, and reoperation for left atrioventricular valve pathology were determined. Patient-reported health status as measured by the Medical Outcomes Study Short Form 12 (SF-12) was obtained for patients without Down syndrome when they were aged older than 15 years.

Results: Repair of PAVSD was done in 133 patients. Median follow-up was 8.7 years for a total of 1541 person-years. Mean age at the initial operation was 5.2 ± 5.1 years (median, 3.4 years). Mean weight was 19.2 ± 16.0 kg (median, 13.2 kg). Survival was 95% at 30 days, 87% at 10 years, and 78% at 30 years. Reoperation for left atrioventricular valve pathology was done 15 patients (11.3%). Lower weight, absence of Down syndrome, and lack of mitral valve cleft repair were significantly associated with undergoing reoperation. Patient-reported health status was obtained in 35 patients. For this group, the mean SF-12 summary scores for the physical component (52.8 ± 9.0) and the mean mental component (50.3 ± 11.0) were not significantly different from age-adjusted norms.

Conclusions: The survival rate for this simple cardiac defect is lower than the general population. In addition, the reoperation rate is significant. Despite this, in general, patients without Down syndrome can expect normal functional health status.