Staged repair for complete atrioventricular septal defect in patients weighing less than 4.0 kg

Kobayashi, Yasuyuki; Kasahara, Shingo; Sano, Shunji; Suzuki, Hiroyuki; Suzuki, Etsuji; Yorifuji, Takashi; Kotani, Yasuhiro

doi:10.1016/j.jtcvs.2023.07.003

Cited by 2 publications

(3 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Transitional AVSD extends beyond the features of partial AVSD and encompasses the presence of a small and restrictive VSD ( 2 , 3 ). Children with partial and transitional AVSD are largely asymptomatic, which leads to the deferral of surgical referral until the preschool or older age stage ( 4 - 6 ). Surgical intervention for uncomplicated incomplete AVSD is generally characterized by its simplicity and overall positive outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Abbruzzese and his colleague have elucidated that preoperative left atrioventricular valve insufficiency and associated valvular malformations are major determinants of late left atrioventricular valve insufficiency in partial AVSD ( 15 ). Furthermore, the study conducted by Kobayashi et al ( 4 ) demonstrated LAVVR as a major cause of late morbidity. Specifically, the postoperative grade of LAVVR is the only independent risk factor for late LAVVR.…”

Section: Introductionmentioning

confidence: 99%

“…Postoperative LAVVR increases volume overload, leading to further left atrioventricular (LV) remodeling and exaggerating the severity of LAVVR. Recurrent LAVVR has been found to be associated with adverse clinical outcomes, sometimes requiring reoperation ( 4 , 15 , 20 - 23 ). However, the risk factors of LAVVR recurrence after partial and transitional AVSD repair have not been well clarified.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Li,

Liu,

Xie

et al. 2024

J Thorac Dis

View full text Add to dashboard Cite

Background Left atrioventricular valvular regurgitation (LAVVR) recurrence after partial and transitional atrioventricular septal defect (AVSD) repair is the main risk factor associated with reoperation or mortality. The purpose of this study was to identify risk factors associated with the recurrence of LAVVR after surgical repair of transitional and partial AVSD at a single institution. Methods A hundred and fifty-seven patients who underwent anatomical repair for partial and transitional AVSD from January 2013 to December 2021 were included in our institutional database. Demographic characteristics, operative information, comorbidities, complications, and outcomes were retrieved from electronic medical records. Echocardiographic evaluations included cardiac dimensions, the degree of LAVVR, and the anatomy of the atrioventricular valve. Results After a median follow-up period of 5.8 years, 40 patients had recurrent moderate or even more severe LAVVR. Compared with patients without recurrent LAVVR, those experiencing LAVVR recurrence were more likely to have larger preoperative left atrial (LA) size and larger left ventricular (LV) size after standardization, larger left atrioventricular valve (LAVV) cleft width, higher proportions of preoperative moderate or even more severe LAVVR, and immediately postoperative mild to moderate or even more severe LAVVR. Univariate Cox regression analysis showed that age at first repair, height, LA size after standardization, LV size after standardization, the severity of preoperative LAVVR, immediately postoperative LAVVR, and the LAVV cleft width more than 1cm were risk factors for recurrent LAVVR (P<0.05 for all). Multivariable Cox regression analysis showed that mild to moderate or even more severe LAVVR postoperatively [hazard ratio (HR) 9.53, 95% confidence interval (CI): 3.78–24.01; P<0.001], the width of LAVV cleft more than 1 cm (HR: 3.90, 95% CI: 1.80–8.48; P<0.001) and age at first repair (HR: 0.45, 95% CI: 0.31–0.66; P<0.001) were independently associated with the recurrence of LAVVR. Conclusions The width of LAVV cleft, mild to moderate or even more severe LAVVR immediately after surgery, and age at initial surgery are risk factors for recurrent LAVVR. The presence of recurrent LAVVR necessitates proactive surveillance to facilitate timely reintervention.

show abstract