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Original Articles: Pediatric Cardiac

Reoperations After Repair of Partial Atrioventricular Septal Defect: A 45-Year Single-Center Experience

Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota

Accepted for publication January 13, 2010.

^_* Address correspondence to Dr Burkhart, Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905 (Email: burkhart.harold{at}mayo.edu).

Presented at the Fifty-sixth Annual Meeting of the Southern Thoracic Surgical Association, Marco Island, FL, Nov 4–7, 2009.

Background: Patients undergoing repair of partial atrioventricular septal defect (AVSD), are reportedly more likely to require reoperation for subaortic obstruction and left atrioventricular valve abnormalities when compared with repair of complete AVSD. Our objective was to examine reoperations after initial repair of partial AVSD, and determine late outcome.

Methods: Between 1962 and 2006, 96 patients (63 female) underwent reoperation at our institution after prior repair of partial AVSD (median interval, 10 years; range, 8 days to 48 years). Median age at first reoperation was 26 years (range, 10 months to 71 years). Indications for the first reoperation included left atrioventricular valve (LAVV) regurgitation in 64 patients (67%), subaortic stenosis in 24 (25%), right atrioventricular valve regurgitation in 21 (22%), residual ASD in 11 (11%), and other in 6 (6%).

Results: The first reoperation included LAVV repair in 38 patients, LAVV replacement in 35, subaortic fibrous resection-myectomy in 22, right atrioventricular valve regurgitation surgery in 19, and other in 14. There were five early deaths (5.2%) after first reoperation; three were prior to 1983. There was no significant difference in 20-year survival after LAVV repair or replacement (69% vs 55%, p = 0.20). At last follow-up (median, 5.2 years; max, 34 years), 81 of 89 late survivors were in New York Heart Association functional class I or II.

Conclusions: The most common indication for reoperation after initial repair of partial AVSD is LAVV pathology, followed by recurrent left ventricular outflow tract obstruction. The need for further reoperation and late survival is similar between patients undergoing valve repair or replacement. When reoperation is required overall late survival is significantly reduced.

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