Outcomes of Partial Atrioventricular Septal Defect Repair in Children
1Sağlık Bilimleri Üniversitesi İstanbul Mehmet Akif Ersoy Göğüs Kalp Ve Damar Cerrahisi Eğitim Ve Araştırma Hastanesi, Çocuk Kalp Ve Damar Cerrahisi, Istanbul, Turkey
2Sağlık Bilimleri Üniversitesi İstanbul Mehmet Akif Ersoy Göğüs Kalp Ve Damar Cerrahisi Eğitim Ve Araştırma Hastanesi, Çocuk Kardiyolojisi, Istanbul, Turkey
Keywords: left atrioventricular valve, regurgitation, reoperation
Objectives: Repair of the partial atrioventricular septal defect (pAVSD) has an excellent survival but reoperation is still an issue. Left atrioventricular (AV) valve regurgitation (LAVVR) is the most common reason for reoperation. This study aimed to retrospectively analyze the results of patients undergoing pAVSD repair to determine the morbidity and mortality rates.
Patients and Methods: Follow-up data of a total of 25 patients younger than 18 years of age, who underwent pAVSD at our centre within the period from 2011 to 2019, were obtained from hospital records. The incidence of Down syndrome, death, complications and reoperation rates were analyzed.
Results: Mean age at operation was 4.64 years. Preoperative LAVVR grade was found to be relatively high in patients who underwent surgery at an older age (p<0.05). Two patients (8%) had Down syndrome. Follow-up ranged from two months to 96 months (mean: 33.48 months). There was no perioperative mortality. Arrhythmia were observed in four patients (16%) after the operation. One patient (4%) had complete AV block requiring permanent pacemaker implantation. The rate of postoperative LAVVR was observed to increase as the time elapsed after the operation increased. The presence of Down syndrome was observed to be protective against postoperative LAVVR (p<0.05). Two patients (8%) had reoperation for LAVVR. The mean time from the initial operation to reoperation was six years. The absence of Down syndrome was found to be a risk factor for reoperation (p<0.05)
Conclusion: Repair of pAVSD is performed with low mortality and favourable outcomes. Major indication for reoperation following the initial repair of pAVSD is LAVVR and regurgitation rate increases as the time elapsed following the operation increases. Furthermore, preoperative LAVVR rate becomes higher as the operation age of the patient increases. Down syndrome is protective in terms of postoperative LAVVR whereas it is a risk factor for reoperation. High reoperation rate suggest the requirement of close follow-up.