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

Presented at the Fifty-sixth Annual Meeting of the Southern Thoracic Surgical Association, Marco Island, FL, Nov 4–7, 2009.
https://doi.org/10.1016/j.athoracsur.2010.01.018Get rights and content

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.

Section snippets

Patients and Methods

The Mayo Foundation Institutional Review Board approved this study, and all patients or their families gave written informed consent. Between January 1962 and January 2006, 96 patients (63 female) underwent reoperation after initial repair of partial AVSD. At initial repair (50 performed elsewhere), median age was six years (range, 55 days to 64 years). Concomitant cardiac operations included secundum atrial septal defect (ASD) repair in two patients, eccentric tricuspid valve annuloplasty in

Results

The first reoperation at our institution represented the patient's first overall reoperation after initial partial AVSD repair in 82 patients and the patient's second overall reoperation in 14. Operative procedures performed at the first reoperation included LAVV repair in 38 patients or LAVV replacement in 35, subaortic fibrous resection-myectomy in 22, tricuspid valve surgery in 19, ASD rerepair in 11, Konno-modified Konno procedure in 2, and apicoaortic conduit in 1. Intraoperative LAVV

Comment

Reduced operative risk and improved long-term outcome after repair of partial AVSD have been demonstrated since the first reported repair in 1955 [6, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26]. In our series, overall early mortality after the first reoperation was 5.2% (5 of 96); over the last 25 years, early mortality was 2.6% (2 of 78). Further, there were no early deaths after subsequent reoperations (n = 28). In addition to low early mortality, we demonstrate that New

References (40)

  • D.M. Goldfaden et al.

    Long-term results of repair of incomplete persistent atrioventricular canal

    J Thorac Cardiovasc Surg

    (1981)
  • M.A. Portman et al.

    A 20-year review of ostium primum defect repair in children

    Am Heart J

    (1985)
  • E.L. Ceithaml et al.

    Long-term results after surgical repair of incomplete endocardial cushion defects

    Ann Thorac Surg

    (1989)
  • M. Bergin et al.

    Partial atrioventricular canal defect: long-term follow-up after initial repair in patients more than 40 years old

    J Am Coll Cardiol

    (1995)
  • R. Burke et al.

    Long-term follow-up after surgical repair of ostium primum atrial septal defect in adults

    J Am Coll Cardiol

    (1996)
  • K. Ackermann et al.

    Replacement of the systemic atrioventricular valve with a mechanical prosthesis in children aged less than 6 years: late clinical results of survival and subsequent replacement

    J Thorac Cardiovasc Surg

    (2007)
  • C.A. Caldarone et al.

    Independent factors associated with longevity of prosthetic pulmonary valves and valved conduits

    J Thorac Cardiovasc Surg

    (2000)
  • G.P. Piccoli et al.

    Left-sided obstructive lesions in atrioventricular septal defects: an anatomic study

    J Thorac Cardiovasc Surg

    (1982)
  • T. Ebels et al.

    Anatomic and functional “obstruction” of the outflow tract in atrioventricular septal defects with separate valve orifices (“ostium primum atrial septal defect”): an echocardiographic study

    Am J Cardiol

    (1984)
  • G.S. van Arsdell et al.

    Subaortic stenosis in the spectrum of atrioventricular septal defectsSolutions may be complex and palliative

    J Thorac Cardiovasc Surg

    (1995)
  • Cited by (0)

    View full text