Modified Single-Patch Technique Versus Two-Patch Technique for the Repair of Complete Atrioventricular Septal Defect: A Meta-Analysis

Abstract

Technical selection for surgical repair of complete atrioventricular septal defect (CAVSD) still remains controversial. This meta-analysis aimed to compare the modified single-patch (MP) technique with the two-patch (TP) technique for patients with CAVSD. Relevant studies comparing the MP technique with the TP technique were identified through a literature search using MEDLINE, EMBASE, Google Scholar, Cochrane Library, and the China National Knowledge Infrastructure databases. The variables were ventricular septal defect (VSD) size, cardiopulmonary bypass (CBP) time, aortic cross-clamp (ACC) time, intensive care unit stay, hospital stay, and other outcomes involving mortality, left ventricular outflow tract obstruction, atrioventricular valve regurgitation, residual septal shunt, atrioventricular block, and reoperation. A random-effect/fixed-effect model was used to summarize the estimates of mean difference/odds ratio with 95% confidence interval. Subgroup analysis stratified by region was performed. Fifteen publications involving 1034 patients were included. This meta-analysis demonstrated that (1) VSD size in the MP group was significantly smaller; (2) CBP time, ACC time, and hospital stay in the MP group experienced improvement; (3) Other postoperative outcomes showed no significant differences between two groups; and (4) The trends in China and other countries were close. The MP and TP techniques had comparable outcomes; however, the MP technique was performed with significantly shorter CBP and ACC times in patients with smaller VSDs. Given this limitation of data, the results of comparison of the two techniques in patients with larger VSDs remain unknown. Further studies are needed.

A review of the Nunn modified single patch technique for atrioventricular septal defect repair

“…However, they also had lower cross-clamp and CPB times and a shorter length of stay compared to those who underwent two-patch repair. They found no significant differences between the two groups in other postoperative outcomes including mortality, LVOT obstruction, residual VSD, complete heart block, and need for reoperation, though they commented that these outcomes have been improving across all repairs (19).…”

Recent advances in managing septal defects: ventricular septal defects and atrioventricular septal defects

“…In some instances, the Australian repair (primary closure of VSD component with septation of the common AV valve, closure of AV valve cleft, primum ASD closure with pericardial patch) may be considered. A recent metal analysis comparing single-patch with two-patch technique demonstrated no significant difference between two groups with comparable outcomes 113 ; however, the cardiopulmonary bypass and aortic cross-clamp times were shorter in the single-patch method of closure of the defect 113 . AV valves are repaired/reconstructed by using the techniques described by Carpentier 114 , Puga and McGoon 115 , or Chopra et al .…”

Repair of complete atrioventricular canal defects: Early and midterm results and comparison of the left anterior leaflet augmentation technique with traditional technics

“…It was emphasized in previous studies that the most important advantage of the MP technique is shortening CPB and ACC time. 9,10 In our research, we found that CPB and ACC times were similar between groups, and there was no statistically significant difference. 10 In our research, it was observed that the mean hospital, ICU stays, and intubation times in the MP group were higher than other groups.…”