Contemporary Outcomes After Repair of Isolated and Complex Complete Atrioventricular Septal Defect

Management of the bad atrioventricular valve in Fontan…time for a change

“…A myriad of different approaches has been reported for the various pathologies of these valves ranging from leaflet resection or augmentation, artificial chordae, cleft (''zone of apposition'') closure, and suture or banded annuloplasty techniques with a 85% to 90% 10-year freedom from reoperation in patients with a biventricular circulation. 11,12 Those who do require reintervention following initial atrioventricular septal defect repair demonstrate disappointing durability even at experienced centers, with Stulak and colleagues 13 reporting a 48% 10-year freedom from reoperation after first reoperation.…”

Commentary: Down or non-Down: It all comes down to the details

“…This is greater than the 9% 10-year reoperation rate we reported after repair of noncomplex AVSD (20% after complex AVSD) in a combined cohort where the majority of patients had T21. 5 Some of these differences could potentially be explained by anatomic differences on the left atrioventricular valve that may make repair more challenging and reintervention more frequent (Figure 1). For example, in the current study with nonsyndromic patients, 20% to 25% of them (depending on complexity) had a deficient mural leaflet and 7% to 13% had a single papillary muscle.…”

“…4 In our study with combined T21 and non-T21 patients, only 5% to 11% had a deficient mural leaflet and 2% to 4% a single papillary muscle. 5 As suggested by Ramgren and colleagues, 4 it is time to reframe the discussion surrounding AVSDs by placing more emphasis on the effect that anatomic complexity, rather than genetics alone, has on outcomes. Only by developing a good understanding of the anatomic nuances that impact outcomes in these patients will we be able to develop strategies to improve those outcomes.…”

Commentary: An ounce of prevention is worth a pound of cure

“…In our experience, rates of postoperative heart block can be reduced to near zero across many intervention types. [4][5][6] The minimally invasive approach described by Nellis and colleagues is an important add-on to our armamentarium, particularly in patients in whom permanent pacing is unavoidable, such as with congenital heart block. This technique will likely require a learning curve for congenital cardiac surgeons who infrequently perform VATS procedures within their normal practice.…”

“…In our experience, rates of postoperative heart block can be reduced to near zero across many intervention types. 4 , 5 , 6 …”