Guocheng Shi1, Huiwen Chen2, Haifa Hong1, Haibo Zhang1, Jinghao Zheng1, Jingfen Liu1, Zhiwei Xu1. 1. Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Heart Center, Shanghai Jiaotong University School of Medicine, Shanghai, China. 2. Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Heart Center, Shanghai Jiaotong University School of Medicine, Shanghai, China hwhwc@hotmail.com.
Abstract
OBJECTIVES: Management of complete atrioventricular (AV) septal defect (CAVSD) with a large ventricular component (>1 cm) remains controversial. The purpose of this study was to assess the feasibility of the one-and-a-half patch technique in repairing this lesion. METHODS: This was a retrospective review of patients undergoing surgical repair of CAVSD with a large ventricular component (>1 cm). Of the 51 patients who were identified in our database (2005-13), 18 underwent the two-patch repair, 12 underwent the modified single-patch repair and 21 underwent the one-and-a-half-patch repair. The CAVSD was combined with tetralogy of Fallot (TOF) in 3 patients and with double-outlet right ventricle (DORV) and pulmonary stenosis (PS) in two individuals in the one-and-a-half-patch group. RESULTS: There were two hospital deaths in the two-patch group, but no deaths in the other two groups. The modified single-patch procedure was associated with the shortest myocardial ischaemic and cardiopulmonary bypass (CPB) times, the two-patch procedure was associated with the longest times and the 1.5-patch procedure times were intermediate. Median follow-up was 35 months (41.6 ± 27.2 months). There were no reoperations in the 1.5-patch group while reintervention was required for 1 patient in the two-patch group (P = 0.252) and 3 patients in the modified single-patch group (P = 0.017). The function of the reconstituted AV valves improved after operation in the 1.5-patch group. No patient in these three groups developed subsequent left ventricular outflow tract obstruction. CONCLUSIONS: The 1.5-patch technique is an attractive clinical option. It produces acceptable mid-term results comparable with two conventional techniques in patients with similarly sized ventricular component.
OBJECTIVES: Management of complete atrioventricular (AV) septal defect (CAVSD) with a large ventricular component (>1 cm) remains controversial. The purpose of this study was to assess the feasibility of the one-and-a-half patch technique in repairing this lesion. METHODS: This was a retrospective review of patients undergoing surgical repair of CAVSD with a large ventricular component (>1 cm). Of the 51 patients who were identified in our database (2005-13), 18 underwent the two-patch repair, 12 underwent the modified single-patch repair and 21 underwent the one-and-a-half-patch repair. The CAVSD was combined with tetralogy of Fallot (TOF) in 3 patients and with double-outlet right ventricle (DORV) and pulmonary stenosis (PS) in two individuals in the one-and-a-half-patch group. RESULTS: There were two hospital deaths in the two-patch group, but no deaths in the other two groups. The modified single-patch procedure was associated with the shortest myocardial ischaemic and cardiopulmonary bypass (CPB) times, the two-patch procedure was associated with the longest times and the 1.5-patch procedure times were intermediate. Median follow-up was 35 months (41.6 ± 27.2 months). There were no reoperations in the 1.5-patch group while reintervention was required for 1 patient in the two-patch group (P = 0.252) and 3 patients in the modified single-patch group (P = 0.017). The function of the reconstituted AV valves improved after operation in the 1.5-patch group. No patient in these three groups developed subsequent left ventricular outflow tract obstruction. CONCLUSIONS: The 1.5-patch technique is an attractive clinical option. It produces acceptable mid-term results comparable with two conventional techniques in patients with similarly sized ventricular component.