Middle to long-term outcomes of surgical repair for atrioventricular septal defect: a single-center study

Abstract

Background: The exact incidence and predictors of mortality and left atrioventricular valve (LAVV) reoperation in congenital atrioventricular septal defect (AVSD) repair are still unclear. This study analyzed the middle to long-term outcomes of surgical repair for AVSD.Methods: A total of 150 patients (69 males and 81 females) who underwent AVSD repair at Children's Hospital of Fudan University from January 2013 to December 2021 were divided into complete defect group (C-group, 67 cases), transitional defect group (T-group, 26 cases), and partial defect group (P-group, 57 cases). Outcomes during the peri-operative and 10-year follow-up periods were evaluated.Results: The total mortality was 5.33% (8/150), including seven early deaths (10.4%) and no late deaths in the C-group, no early deaths (0%) and one late death (1.8%) in the P-group, and no early or late deaths in the T-group. Up to the last follow-up, severe LAVV regurgitation had occurred in 27 patients, including 16 in the C-group, four in the T-group, and seven in the P-group. In total, 12 (12/150, 8.0%) patients received LAVV re-operation, including seven in the C-group, three in the T-group, and two in the P-group. Cox regression analysis showed that pre-operative severe pulmonary hypertension (P=0.006) and severe LAVV regurgitation within 24 hours after the first surgery (P=0.023) were independent risk factors for mortality.≥ Moderate LAVV regurgitation within the first 24 hours after surgery (P=0.014) was an independent risk factor for LAVV re-operation.Conclusions: Complete AVSD repair increased the risk of early death, severe LAVV regurgitation and reoperation. Pre-operative severe pulmonary hypertension and residual severe LAVV regurgitation indicated high risk for mortality. ≥ Moderate LAVV regurgitation within 24 hours after the first surgery predicted a high probability of LAVV re-operation.

Retrospective Comparative Study of Total Repair of Partial Atrioventricular Canal Before and After Two Year Old Age

“…Our results were supported by the study of [24] as they reported that The early mortality rate was 2.5% (1/40). The survival rate was 90% (95% CI: 76-96) at 10 years and 83% (95% CI: 60-94) at 20 years.…”

Risk factors for the recurrence of left atrioventricular valvular regurgitation after surgical repair of partial and transitional atrioventricular septal defect

“…The LAVVR recurrent rate is lower than the rate reported by Fortuna and his colleagues ( 29 ). The estimated overall mortality and re-operation rate were 2.5% and 6.4% in our study, which were similar to previous studies ( 30 - 32 ).…”

A stitch in time: age impacts survival in repair of atrioventricular septal defects

“…However, a deeper analysis reveals that there was a very high rate of preoperative moderate or greater LAVV regurgitation and pulmonary hypertension, which were two of the major factors associated with mortality. Moderate or greater LAVV regurgitation was present in 76.1% of patients with complete AVSD in this study (10), compared to 20% of our patients in Melbourne (2) and 30% in Texas (4). Both LAVV regurgitation and pulmonary hypertension were particularly common in patients under 3 months of age, who were also at increased risk of mortality.…”

“…Cai et al (10) report their experience with 150 patients across the spectrum of AVSD who underwent complete repair at Fudan University between 2013 and 2021. They observed an early mortality of 10% in the complete AVSD group, 1.8% in the partial AVSD group and 0% in the transitional AVSD group.…”