Complete Versus Partial Atrioventricular Canal: Equal Risks of Repair in the Modern Era

Abstract

ObjectiveTo assess the authors' hypothesis that with modern techniques, the current risks of repair for both complete and partial atrioventricular canal (AVC) are equal. Summary Background DataRepair of complete AVC in infancy has traditionally carried a substantial mortality. In contrast, partial AVC has been considered low-risk for repair and can be performed later in childhood. MethodsThis was a retrospective review of 63 infants and children who underwent complete (n ϭ 40) or partial AVC repair (n ϭ 23) from 1990 to 2001. Among complete AVC patients, the ventriculoseptal defect was repaired via an individualized approach according to each patient's specific anatomy: direct suturing without a patch (n ϭ 5) and/or interposition of a small pericardial patch with a running suture (n ϭ 35). In all 63 patients the left AV valve cleft was closed with interrupted sutures, and all atrial defects were closed with a pericardial patch. Data were analyzed with the Student t test and Fisher exact test. ResultsResults are expressed as the mean Ϯ SEM. Age at operation was 6.3 Ϯ 2.0 months for complete AVC and 47.5 Ϯ 6.1 months for partial AVC (P Ͻ .001). Bypass time was 65.2 Ϯ 2.3 minutes for complete AVC and 58.3 Ϯ 3.9 minutes for partial AVC (P ϭ .1). Reoperation rate was 7.5% (3/40) for complete AVC and 13.0% (3/23) for partial AVC (P ϭ .6). Early mortality was 2.5% (1/40) for complete AVC and 0% (0/23) for partial AVC (P ϭ .6). ConclusionsCompared to partial AVC, patients presenting for complete AVC repair are significantly younger and manifest more complex anatomy and pathophysiology. However, utilizing modern techniques, including an individualized surgical approach to the ventricular component, repair of complete AVC yields reoperation and early mortality rates similar to those of partial AVC.Current wisdom dictates that complete atrioventricular canal (AVC) should be repaired within the first 6 months of life to avert the onset of progressive pulmonary hypertension.1,2 In previous decades repair of complete AVC in infancy was attended by a substantial early mortality. 2-4Although early outcomes have improved in recent years, the preferred operative technique for complete AVC repair remains somewhat controversial. For example, there continue to be proponents of either the single-or double-patch technique, with either approach yielding acceptable results. 2-5Additional controversies have focused on the necessity of dividing the bridging leaflets to facilitate ventricular septal exposure in the two-patch technique, as well as whether the septal commissure (i.e., "cleft") of the left AV valve should be closed or left open.These unresolved controversies regarding the optimal surgical management of complete AVC were but one factor inspiring us toward a different approach. In addition, we realized that the pathologic anatomy of complete AVC is highly variable among patients with this lesion, 6 -8 indicat-

The left atrioventricular valve in partial atrioventricular septal defect: management strategy and surgical outcome

“…Our experience confirms that a PAVSD can be repaired with a low operative (3%) and no late mortality. These results are similar to other studies (0% [5,6], 1.6% [7], 6% [8], 7.9% [9], 10.7% [10], and 13% [11]). Correction of a PAVSD may be challenging because of difficulties in repairing the LAVV.…”

Complete atrioventricular canal repair with a decellularized porcine small intestinal submucosa patch

“…Furthermore, in the present series, only 3 (4%) patients required reoperation specifically for their left AVV, which compared favorably with previously published reports. 6,8,11,15,[18][19][20][21][22][23][24][25] The rate of left AVV plasty or replacement is higher at 5 (6.8%) and 1 (1.3%), respectively, because some of the patients who had reoperations for residual septal defects also underwent "touch-up" procedures on their AVV's that they wouldn't have needed otherwise. Finally, the incidence of LVOTO requiring reintervention after primary repair of CAVC reported in the literature varies from 0.5% to 4.5%, 15,[26][27][28][29] which again compares favorably with our rate of 1.3%.…”

Prolonged Recovery from Pediatric Cardiac Surgery Due to Disseminated Cytomegalovirus Infection

“…Operative mortality for all patients with atrioventricular septal defect is less than 2%. Moreover, prolonged or complicated postoperative courses, especially for those with partial defects, are uncommon 1 . We report a case of an infant with partial atrioventricular septal defect who underwent an uncomplicated repair yet developed persistent respiratory insufficiency postoperatively leading to a prolonged recovery.…”

“…Moreover, prolonged or complicated postoperative courses, especially for those with partial defects, are uncommon. 1 We report a case of an infant with partial atrioventricular septal defect who underwent an uncomplicated repair yet developed persistent respiratory insufficiency postoperatively leading to a prolonged recovery. After an extensive diagnostic evaluation, disseminated cytomegalovirus infection was identified as the cause.…”