Author + information
- Jessica Bowman,
- Harold Burkhart,
- Adele Goodloe,
- Joseph Dearani,
- Sabrina Phillips,
- Benjamin Eidem and
- Frank Cetta
Surgical repair of partial atrioventricular septal defects (AVSD) has been successful for over 60 years. Recent data from the Pediatric Heart Network (PHN) show that 31% of patients had moderate/severe left atrioventricular valve regurgitation (LAVVR) at 6 month postoperative. In contrast, previous reports, including data published by our institution, found that only 9% of patients developed more than moderate LAVVR postoperative. Our objective was to determine the long-term outcomes after repair of partial AVSD in the current era and compare those to the PHN data and the earlier experience at our institution.
Clinical records were reviewed for all patients with partial (including transitional) AVSD who had biventricular repair between 5/1999 and 6/2011 at our institution. Kaplan-Meier method was used to determine survival and potential risk factors were evaluated using Cox proportional hazards models.
Seventy-three patients had repair of partial AVSD during the study time frame. Nineteen (26%) had Down syndrome. Median age at surgery was 9.5 years. Survival at 1-year was 95.1%. Median follow-up was 2.3 years (IQR, 0.3-5.3). At five years postoperative, survival-free of reoperation was 80.1%. Nine patients (12%) required reoperation. Reasons for reoperation included: LAVVR (n=6), LAVV stenosis (n=1), residual ASD (n=1), and relief of LVOTO (n=1). Seven patients (5 within 2 years) developed more than moderate LAVVR with a cumulative incidence of 10.8% by 2 years. None of the patients with Down Syndrome have developed greater than moderate LAVVR. Patient age at surgery (p=0.14) and severity of preop LAVVR (p=0.39) were not identified as statistically significant risk factors for postop LAVVR.
Morbidity and mortality following surgical repair for partial AVSD remain low. The most common reason for reoperation is LAVVR. 10.8% of patients developed more than moderate LAVVR by 2 years postop. These data are in contrast to the PHN data, and our cohort had a longer follow-up period. Additionally, the rate of development of LAVVR was similar in our current cohort when compared to the earlier cohort.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Congenital Cardiology Solutions: Surgical Outcomes
Abstract Category: 13. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1118-122
- 2013 American College of Cardiology Foundation