Outcomes of Partial Atrioventricular Septal Defect Repair in Children
Görkem Çitoğlu1, Serhat Bahadır Genç1, Hacer Kamalı2, Fatma Sevinç Şengül2, İsmihan Selen Onan1
1Department of Pediatric Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Health Sciences University, Istanbul, Turkey
2Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Health Sciences University, Istanbul, Turkey
Keywords: Left atrioventricular valve; regurgitation; reoperation
Introduction: Repair of the partial atrioventricular septal defect (pAVSD) has an excellent survival but re- operation is still an issue. Left atrioventricular 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= 0.027). Two patients (8%) had Down syndrome. Fol- low-up ranged from 2 months to 96 months (mean: 33.48 months). There was no perioperative mortality. Arrhythmia were observed in 4 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< 0.01). 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< 0.01).
Conclusion: Repair of pAVSD is performed with low mortality and favourable outcomes. Most common reason for reoperation following the repair of pAVSD is LAVVR and regurgitation rate increases as the time elapsed following the initial 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 and its absence is a risk factor for reoperation. High reoperation rates suggest the requirement of close follow-up.