Edward Buratto1, Xin Tao Ye1, Andrew Bullock2, Andrew Kelly3, Yves d'Udekem4, Christian P Brizard4, Igor E Konstantinov5. 1. Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia The University of Melbourne, Melbourne, Australia. 2. Princess Margaret Children's Hospital, Perth, Australia. 3. Adelaide Women's and Children's Hospital, Adelaide, Australia. 4. Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia The University of Melbourne, Melbourne, Australia Murdoch Children's Research Institute, Melbourne, Australia. 5. Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia The University of Melbourne, Melbourne, Australia Murdoch Children's Research Institute, Melbourne, Australia igor.konstantinov@rch.org.au.
Abstract
OBJECTIVES: Partial atrioventricular septal defect (pAVSD) is repaired with excellent long-term survival. However, up to 25% of patients require reoperations. This study reviews results of reoperation following pAVSD repair at a single institution. METHODS: From 1975 to 2012, 40 patients (16%, 40/246) underwent reoperation following pAVSD repair at the study institution. The data were retrospectively reviewed. RESULTS: The mean time to reoperation was 5.4 ± 5.8 years. The most common reoperations were left atrioventricular valve (LAVV) surgery (78%, 31/40) and resection of left ventricular outflow tract obstruction (20%, 8/40). The most common cause for LAVV surgery was regurgitation through the cleft (58%, 18/31), followed by central regurgitation (29%, 9/31). Most cases of LAVV regurgitation were treated by repair (77%, 24/31), rather than replacement (23%, 7/31). Since the introduction of a patch augmentation technique for LAVV repair in 1998, the rate of repair has increased from 54 to 94% (P = 0.012). The early mortality rate was 2.5% (1/40). The survival rate was 90% (95% CI: 76-96) at 10 years and 83% (95% CI: 60-94) at 20 years. The rate of freedom from further reoperation was 66% (95% CI: 46-80) at 10- and 20-year follow-up. CONCLUSIONS: The most common cause for reoperation following pAVSD repair was LAVV regurgitation through the LAVV cleft. Reoperation is performed with survival comparable to that of primary pAVSD repair, yet the rate of further reoperations remains high. The patch augmentation technique for LAVVR has significantly increased the rate of successful LAVV repair.
OBJECTIVES: Partial atrioventricular septal defect (pAVSD) is repaired with excellent long-term survival. However, up to 25% of patients require reoperations. This study reviews results of reoperation following pAVSD repair at a single institution. METHODS: From 1975 to 2012, 40 patients (16%, 40/246) underwent reoperation following pAVSD repair at the study institution. The data were retrospectively reviewed. RESULTS: The mean time to reoperation was 5.4 ± 5.8 years. The most common reoperations were left atrioventricular valve (LAVV) surgery (78%, 31/40) and resection of left ventricular outflow tract obstruction (20%, 8/40). The most common cause for LAVV surgery was regurgitation through the cleft (58%, 18/31), followed by central regurgitation (29%, 9/31). Most cases of LAVV regurgitation were treated by repair (77%, 24/31), rather than replacement (23%, 7/31). Since the introduction of a patch augmentation technique for LAVV repair in 1998, the rate of repair has increased from 54 to 94% (P = 0.012). The early mortality rate was 2.5% (1/40). The survival rate was 90% (95% CI: 76-96) at 10 years and 83% (95% CI: 60-94) at 20 years. The rate of freedom from further reoperation was 66% (95% CI: 46-80) at 10- and 20-year follow-up. CONCLUSIONS: The most common cause for reoperation following pAVSD repair was LAVV regurgitation through the LAVV cleft. Reoperation is performed with survival comparable to that of primary pAVSD repair, yet the rate of further reoperations remains high. The patch augmentation technique for LAVVR has significantly increased the rate of successful LAVV repair.
Authors: Yaroslav Ivanov; Edward Buratto; Phillip Naimo; Adrienne Lui; Thomas Hu; Yves d'Udekem; Christian P Brizard; Igor E Konstantinov Journal: Interact Cardiovasc Thorac Surg Date: 2022-03-31