Outcomes and reoperations after total correction of complete atrio-ventricular septal defect

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Serval ID
serval:BIB_125F6976F1D7
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Outcomes and reoperations after total correction of complete atrio-ventricular septal defect
Journal
European journal of cardio-thoracic surgery
Author(s)
Dodge-Khatami Ali, Herger Stefan, Rousson Valentin, Comber Maurice, Knisrch Walter, Bauersfeld Urs, Prêtre René
ISSN
1873-734X[electronic]
Publication state
Published
Issued date
2008
Peer-reviewed
Oui
Volume
34
Number
4
Pages
745-750
Language
english
Abstract
BACKGROUND: Surgical correction of complete atrio-ventricular septal defect (AVSD) achieves satisfactory results with low morbidity and mortality, but may require reoperation. Our recent operative results at mid-term were followed-up. METHODS: From June 2000 to December 2007, 81 patients (Down syndrome; n=60), median age 4.0 months (range 0.7-118.6) and weight 4.7kg (range 2.2-33), underwent complete AVSD correction. Patch closure for the ventricular septal defect (VSD; n=69) and atrial septal defect (ASD; n=42) was performed with left atrio-ventricular valve (LAVV) cleft closure (n=76) and right atrio-ventricular valve (RAVV) repair (n=57). Mortality, morbidity, and indications for reoperation were retrospectively studied; the end point 'time to reoperation' was analyzed using Kaplan-Meier curves. Follow-up was complete except in two patients and spanned a median of 28 months (range 0.4-6.1 years). RESULTS: In-hospital mortality was 3.7% (n=3) and one late death occurred. Reoperation was required in 7/79 patients (8.9%) for LAVV insufficiency (n=4), for a residual ASD (n=1), for right atrio-ventricular valve insufficiency (n=1), and for subaortic stenosis (n=1). At last follow-up, no or only mild LAVV and RAVV insufficiency was present in 81.3% and 92.1% of patients, respectively, and 2/3 of patients were medication-free. Risk factors for reoperation were younger age (<3 months; p=0.001) and lower weight (<4kg; p=0.003), and a trend towards less and later reoperations in Down syndrome (p<0.2). CONCLUSIONS: Surgical correction of AVSD can be achieved with low mortality and need for reoperation, regardless of Down syndrome or not. Immediate postoperative moderate or more residual atrio-ventricular valve insufficiency will eventually require a reoperation, and could be anticipated in patients younger than 3 months and weighing <4kg.
Keywords
Age Factors, Body Weight, Child, Child, Preschool, Down Syndrome, Down Syndrome/surgery, Epidemiologic Methods, Female, Heart Septal Defects, Atrial, Heart Septal Defects, Atrial/surgery, Heart Septal Defects, Ventricular, Heart Septal Defects, Ventricular/surgery, Humans, Infant, Male, Reoperation, Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
10/03/2009 14:50
Last modification date
25/09/2019 6:08
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