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Veličković VM, Borisenko O, Svensson M, Spelman T, Siebert U. Congenital heart defect repair with ADAPT tissue engineered pericardium scaffold: An early-stage health economic model. PLoS One 2018; 13:e0204643. [PMID: 30261033 PMCID: PMC6160133 DOI: 10.1371/journal.pone.0204643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 09/12/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the cost effectiveness of tissue engineered bovine tissue pericardium scaffold (CardioCel) for the repair of congenital heart defects in comparison with surgery using xenogeneic, autologous, and synthetic patches over a 40-year time horizon from the perspective of the UK National Health Service. METHODS A six-state Markov state-transition model to model natural history of disease and difference in the interventional effect of surgeries depending on patch type implanted. Patches differed regarding their probability of re-operation due to patch calcification, based on a systematic literature review. Transition probabilities were based on the published literature, other clinical inputs were based on UK registry data, and cost data were based on UK sources and the published literature. Incremental cost-effectiveness ratio (ICER) was determined as incremental costs per quality adjusted life years (QALY) gained. We used a 40-year analytic time-horizon and adopted the payer perspective. Comprehensive sensitivity analyses were performed. RESULTS According to the model predictions, CardioCel was associated with reduced incidence of re-operation, increased QALY, and costs savings compared to all other patches. Cost savings were greatest compared to synthetic patches. Estimated cost savings associated with CardioCel were greatest within atrioventricular septal defect repair and lowest for ventricular septal defect repair. Based on our model, CardioCel relative risk for re-operations is 0.938, 0.956and 0.902 relative to xenogeneic, autologous, and synthetic patches, respectively. CONCLUSION CardioCel was estimated to increase health benefits and save cost when used during surgery for congenital heart defects instead of other patches.
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Affiliation(s)
- Vladica M. Veličković
- Synergus AB, Health Economics and Evidence Synthesis Department, Stockholm, Sweden
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Reseaech and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Oleg Borisenko
- Synergus AB, Health Economics and Evidence Synthesis Department, Stockholm, Sweden
| | - Mikael Svensson
- Health Metrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tim Spelman
- Synergus AB, Health Economics and Evidence Synthesis Department, Stockholm, Sweden
- Centre for Population Health, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Reseaech and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
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Çelik M, Gökdemir M, Cındık N, Özkan M. Hybrid approach: an alternative prior to corrective surgery in a patient with arch hypoplasia and complete atrioventricular septal defect. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2018; 26:473-475. [PMID: 32082782 PMCID: PMC7018266 DOI: 10.5606/tgkdc.dergisi.2018.15417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/09/2018] [Indexed: 11/21/2022]
Abstract
The hybrid approach is mostly preferred in patients with hypoplastic left heart syndrome or univentricular physiology. Here, the hybrid approach is applied as a palliative procedure prior to corrective surgery in a patient with complete atrioventricular septal defect associated with arcus hypoplasia and results are discussed according to the literature.
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Affiliation(s)
- Mehmet Çelik
- Department of Cardiovascular Surgery, Başkent University Konya Medical and Research Center, Konya, Turkey
| | - Mahmut Gökdemir
- Department of Pediatric Cardiology, Başkent University Konya Medical and Research Center, Konya, Turkey
| | - Nimet Cındık
- Department of Pediatric Cardiology, Başkent University Konya Medical and Research Center, Konya, Turkey
| | - Murat Özkan
- Department of Cardiovascular Surgery, Başkent University Faculty of Medicine, Ankara, Turkey
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Rao PS, Harris AD. Recent advances in managing septal defects: ventricular septal defects and atrioventricular septal defects. F1000Res 2018; 7. [PMID: 29770201 PMCID: PMC5931264 DOI: 10.12688/f1000research.14102.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 12/18/2022] Open
Abstract
This review discusses the management of ventricular septal defects (VSDs) and atrioventricular septal defects (AVSDs). There are several types of VSDs: perimembranous, supracristal, atrioventricular septal, and muscular. The indications for closure are moderate to large VSDs with enlarged left atrium and left ventricle or elevated pulmonary artery pressure (or both) and a pulmonary-to-systemic flow ratio greater than 2:1. Surgical closure is recommended for large perimembranous VSDs, supracristal VSDs, and VSDs with aortic valve prolapse. Large muscular VSDs may be closed by percutaneous techniques. A large number of devices have been used in the past for VSD occlusion, but currently Amplatzer Muscular VSD Occluder is the only device approved by the US Food and Drug Administration for clinical use. A hybrid approach may be used for large muscular VSDs in small babies. Timely intervention to prevent pulmonary vascular obstructive disease (PVOD) is germane in the management of these babies. There are several types of AVSDs: partial, transitional, intermediate, and complete. Complete AVSDs are also classified as balanced and unbalanced. All intermediate and complete balanced AVSDs require surgical correction, and early repair is needed to prevent the onset of PVOD. Surgical correction with closure of atrial septal defect and VSD, along with repair and reconstruction of atrioventricular valves, is recommended. Palliative pulmonary artery banding may be considered in babies weighing less than 5 kg and those with significant co-morbidities. The management of unbalanced AVSDs is more complex, and staged single-ventricle palliation is the common management strategy. However, recent data suggest that achieving two-ventricle repair may be a better option in patients with suitable anatomy, particularly in patients in whom outcomes of single-ventricle palliation are less than optimal. The majority of treatment modes in the management of VSDs and AVSDs are safe and effective and prevent the development of PVOD and cardiac dysfunction.
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Affiliation(s)
- P Syamasundar Rao
- University of Texas-Houston McGovern Medical School, Children Memorial Hermann Hospital, Houston, USA
| | - Andrea D Harris
- Pediatrix Cardiology Associates of New Mexico, Albuquerque, USA
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Buratto E, Khoo B, Ye XT, Daley M, Brizard CP, d'Udekem Y, Konstantinov IE. Long-Term Outcome After Pulmonary Artery Banding in Children With Atrioventricular Septal Defects. Ann Thorac Surg 2018; 106:138-144. [PMID: 29627386 DOI: 10.1016/j.athoracsur.2018.02.086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with atrioventricular septal defect (AVSD) may require pulmonary artery banding (PAB), either as a part of a staged univentricular palliation or to allow delayed biventricular repair in patients presenting with early heart failure. The long-term outcomes of PAB in children with AVSD have not been previously reported. METHODS All children with AVSD who underwent PAB at a single institution were included in the study. Data were obtained from medical records and correspondence with general practitioners and cardiologists. RESULTS A total of 68 patients with complete AVSD underwent PAB, of whom 58.8% of patients (40 of 68) had balanced AVSD (bAVSD) and underwent PAB with intent to subsequently perform biventricular repair. The remaining 41.2% of patients (28 of 68) had unbalanced AVSD (uAVSD) and underwent PAB as part of staged univentricular repair. PAB was not associated with a short-term increase in atrioventricular valve (AVV) regurgitation (p = 0.24). In patients with bAVSD, 83.8% (95% confidence interval [CI]: 67.4% to 92.4%) achieved biventricular repair. Survival was 73.4% (95% CI: 54.3% to 85.5%) and freedom from left AVV operation was 60.0% (95% CI: 36.1% to 77.4%) at 20 years of follow-up. In patients with uAVSD, 61.9% (95% CI: 40.5% to 77.5%) had achieved Fontan completion at 10 years of follow-up. Survival was 60.9% (95% CI: 36.2% to 78.5%) and freedom from AVV operation was 78.6% (95% CI: 55.5% to 90.6%) at 20 years. CONCLUSIONS PAB can be used in patients with AVSD without compromising AVV function. Most patients with bAVSD progress to biventricular repair, albeit with a high rate of AVV reoperation. Patients with uAVSD who undergo PAB have similar outcomes to the overall uAVSD population.
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Affiliation(s)
- Edward Buratto
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Brandon Khoo
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Xin Tao Ye
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Michael Daley
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
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Geoffrion TR, Singappuli K, Murala JSK. A review of the Nunn modified single patch technique for atrioventricular septal defect repair. Transl Pediatr 2018; 7:91-103. [PMID: 29770291 PMCID: PMC5938247 DOI: 10.21037/tp.2018.02.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Atrioventricular septal defect (AVSD) is a common congenital cardiac surgical problem. Over the years, younger and smaller infants are having operations for this condition before irreversible cardio pulmonary changes occur. Traditionally a single or two patch techniques have been used to repair this defect. However, in the past two decades an innovative method of modified single patch technique popularized by Dr. Graham Nunn has gained worldwide popularity. This review discusses the origin, surgical principles, technique and outcomes of this method, popularly known as Nunn or Australian technique. Research comparing the modified single patch technique to classic single and double patch techniques has shown good preservation of atrioventricular valve function, no residual ventricular septal defect (VSDs), low incidence of left ventricular outflow obstruction, preserved conduction, easy reproducibility, and improved perioperative and long-term mortality.
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Affiliation(s)
- Tracy R Geoffrion
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kanchana Singappuli
- Department of Pediatric Cardiac Surgery, Lady Ridgeway Hospital for Children, Dr. Denister De Silva Mawatha, Colombo, Sri Lanka
| | - John S K Murala
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Kharbanda RK, Blom NA, Hazekamp MG, Yildiz P, Mulder BJ, Wolterbeek R, Weijerman ME, Schalij MJ, Jongbloed MR, Roest AA. Incidence and risk factors of post-operative arrhythmias and sudden cardiac death after atrioventricular septal defect (AVSD) correction: Up to 47 years of follow-up. Int J Cardiol 2018; 252:88-93. [DOI: 10.1016/j.ijcard.2017.09.209] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/30/2017] [Accepted: 09/28/2017] [Indexed: 12/01/2022]
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Chauhan S. Atrioventricular septal defects. Ann Card Anaesth 2018; 21:1-3. [PMID: 29336382 PMCID: PMC5791475 DOI: 10.4103/aca.aca_219_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sandeep Chauhan
- Department of Cardiac Anaesthesia, CN Center, AIIMS, New Delhi, India
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Krupickova S, Morgan GJ, Cheang MH, Rigby ML, Franklin RC, Battista A, Spanaki A, Bonello B, Ghez O, Anderson D, Tsang V, Michielon G, Marek J, Fraisse A. Symptomatic partial and transitional atrioventricular septal defect repaired in infancy. Heart 2017; 104:1411-1416. [DOI: 10.1136/heartjnl-2017-312195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/17/2017] [Accepted: 12/06/2017] [Indexed: 11/03/2022] Open
Abstract
ObjectivesInfants with symptomatic partial and transitional atrioventricular septal defect undergoing early surgical repair are thought to be at greater risk. However, the outcome and risk profile of this cohort of patients are poorly defined. The aim of this study was to investigate the outcome of symptomatic infants undergoing early repair and to identify risk factors which may predict mortality and reoperation.MethodsThis multicentre study recruited 51 patients (24 female) in three tertiary centres between 2000 and 2015. The inclusion criteria were as follows: (1) partial and transitional atrioventricular septal defect, (2) heart failure unresponsive to treatment, (3) biventricular repair during the first year of life.ResultsMedian age at definitive surgery was 179 (range 0–357) days. Sixteen patients (31%) had unfavourable anatomy of the left atrioventricular valve: dysplastic (n=7), double orifice (n=3), severely deficient valve leaflets (n=1), hypoplastic left atrioventricular orifice and/or mural leaflet (n=3), short/poorly defined chords (n=2). There were three inhospital deaths (5.9%) after primary repair. Eleven patients (22%) were reoperated at a median interval of 40 days (4 days to 5.1 years) for severe left atrioventricular valve regurgitation and/or stenosis. One patient required mechanical replacement of the left atrioventricular valve. After median follow-up of 3.8 years (0.1–11.4 years), all patients were in New York Heart Association (NYHA) class I. In multivariable analysis, unfavourable anatomy of the left atrioventricular valve was the only risk factor associated with left atrioventricular valve reoperation.ConclusionsAlthough surgical repair is successful in the majority of the cases, patients with partial and transitional atrioventricular septal defect undergoing surgical repair during infancy experience significant morbidity and mortality. The reoperation rate is high with unfavourable left atrioventricular valve anatomy.
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IJsselhof R, Gauvreau K, Del Nido P, Nathan M. Technical Performance Score: Predictor of Outcomes in Complete Atrioventricular Septal Defect Repair. Ann Thorac Surg 2017. [PMID: 28648535 DOI: 10.1016/j.athoracsur.2017.03.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Technical performance score (TPS) has been associated with both early and late outcomes across a wide range of congenital cardiac procedures. We sought to validate TPS as predictor of outcomes for complete atrioventricular septal defect (CAVSD) repair. METHODS This was a single-center retrospective review of patients after balanced CAVSD repair between January 1, 2000, and March 1, 2016. We assigned TPS (class 1, no residua; class 2, minor residua; class 3, major residua or reintervention before discharge for residua) based on summation of subcomponent scores from discharge echocardiograms. Outcomes of interest were in-hospital complications, postoperative days on ventilator, and postdischarge reintervention. RESULTS Among 350 patients, median age was 3.2 months (interquartile range [IQR], 2.4 to 4.2 months). Fifty-four patients (16%) had class 1 TPS, 218 (62%) class 2, 63 (18%) class 3, and 15 (4%) were unscorable. There were 36 complications (10%), and median postoperative days on ventilator were 2 (IQR, 1 to 3) days. There were 34 postdischarge reinterventions (10%). Median follow-up was 2.6 years (IQR, 0.09 to 7.9) years. On multivariable modeling, class 3 TPS was associated with complications (odds ratio 5.45, 95% confidence interval [CI]: 1.06 to 28.1, p = 0.04), prolonged postoperative ventilator days (hazard ratio [HR] 0.54, 95% CI: 0.37 to 0.80, p = 0.002), and postdischarge reintervention (HR 5.61, 95% CI: 1.28 to 24.5, p = 0.02) after adjusting for covariates such as age, weight, genetic abnormality, concomitant procedure, prematurity, and second bypass run. CONCLUSIONS At our center, CAVSD repair was associated with low morbidity. TPS may identify patients with complications, prolonged days on ventilator, and who require postdischarge reinterventions; thus, it provides feedback on areas of improvement and allows identification of patients who warrant closer follow-up.
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Affiliation(s)
| | - Kim Gauvreau
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pedro Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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Imaging of left-to-right shunt in adults. Curr Opin Cardiol 2017; 32:475-481. [PMID: 28590259 DOI: 10.1097/hco.0000000000000423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Left-to-right shunts are commonly seen in congenital heart diseases. This review aims to review the anatomy, physiology, and imaging of the four most common left-to-right lesions in adults. RECENT FINDINGS Reported late complications of left-to-right lesions provide guidance in follow-up imaging. Use of three-dimensional echocardiography helps not only in the diagnosis of these defects but also in assistance during device closure. SUMMARY Noninvasive imaging plays a significant role in the diagnosis and management of left-to-right lesions.
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Ashfaq A, Brown T, Reemtsen B. Repair of Complete Atrioventricular Septal Defects With Decellularized Extracellular Matrix: Initial and Midterm Outcomes. World J Pediatr Congenit Heart Surg 2017; 8:310-314. [DOI: 10.1177/2150135116684797] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Since April 2010, our institution has repaired complete atrioventricular septal defects (CAVSDs) with a two-patch technique utilizing CorMatrix extracellular material. This material is potentially an attractive patch because of its theorized eventual integration with the host tissue. We sought to analyze initial outcomes of CAVSD repair with CorMatrix. Methods: Data were collected on consecutive pediatric (age <18) patients receiving two-patch CAVSD repairs with CorMatrix at a single institution from April 2010 to July 2014. Baseline and perioperative characteristics were evaluated. Echocardiograms were evaluated in both the immediate postoperative period and the most recent postoperative follow-up. Variables analyzed included left AV valve performance, residual shunting, left ventricular outflow tract (LVOT) gradient, morbidity, and mortality. Results: Fifteen patients were identified. The average age at operation was 205 days, with mean follow-up time at 1,364 days. Echocardiograms revealed the following: 12 (80%) patients showed either improved or stable left AV valve performance remaining at “mild” or less insufficiency, while two (13%) declined from “none” to mild and one (7%) from mild to “severe,” which required reoperation. There was no residual shunting or LVOT obstruction at follow-up. The single (7%) reoperation was performed after three years due to left AV valve zone of apposition dehiscence. No permanent pacemakers were needed, and no deaths were reported. Conclusion: Our initial experience with CorMatrix in the repair of CAVSD in children has resulted in good initial and midterm outcomes. The CorMatrix patch remained stable through midterm follow-up, thus may be efficacious for use in CAVSD repair.
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Affiliation(s)
- Adeel Ashfaq
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tyler Brown
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Brian Reemtsen
- Mattel Children’s Hospital, University of California, Los Angeles, Los Angeles, CA, USA
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Congenital Heart Disease: Atrioventricular Septal Defects. Anesthesiology 2017. [DOI: 10.1007/978-3-319-50141-3_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Vida VL, Tessari C, Castaldi B, Padalino MA, Milanesi O, Gregori D, Stellin G. Early Correction of Common Atrioventricular Septal Defects: A Single-Center 20-Year Experience. Ann Thorac Surg 2016; 102:2044-2051. [DOI: 10.1016/j.athoracsur.2016.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/21/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
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Long-Term Outcome of Patients With Complete Atrioventricular Septal Defect Combined With the Tetralogy of Fallot: Staged Repair Is Not Inferior to Primary Repair. Ann Thorac Surg 2016; 103:876-880. [PMID: 27692233 DOI: 10.1016/j.athoracsur.2016.07.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/08/2016] [Accepted: 07/11/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Primary repair is the preferred strategy for surgical treatment of complete atrioventricular septal defect combined with the tetralogy of Fallot. However, a staged approach may be preferable for very small or cyanotic infants. The long-term outcomes of infants undergoing staged vs primary repair were compared. METHODS Data from 47 patients with complete atrioventricular septal defect combined with the tetralogy of Fallot who were operated on at our institution between 1974 and 2013 were reviewed. The study end points were all-cause death and reoperation. The patients were classified into two groups: staged repair (SR) and primary repair (PR). The indications for staged repair were cyanosis and young age. RESULTS There were 22 SR and 25 PR patients. The SR patients were younger at the time of the initial operation (p = 0.001), and were more frequently cyanotic (21 SR vs 5 PR patients, p = 0.003). The 10-year survival after repair of the SR and PR patients was 78% ± 11% and 83% ± 8%, respectively (p = 0.8). No risk factors for death were identified. The 10-year freedom from reoperation for atrioventricular valve regurgitation of SR and PR patients after repair was 73% ± 12% and 71% ± 10%, respectively (p = 0.5). At least moderate atrioventricular valve regurgitation before repair was the only risk factor for reoperation (p = 0.01). CONCLUSIONS Cyanotic and very young children with complete atrioventricular septal defect combined with the tetralogy of Fallot who require urgent treatment have long-term outcomes after staged repair similar to those of patients who undergo primary repair. Preoperative atrioventricular valve regurgitation is associated with increased risk for reoperation over the long-term.
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Altered left ventricular vortex ring formation by 4-dimensional flow magnetic resonance imaging after repair of atrioventricular septal defects. J Thorac Cardiovasc Surg 2015; 150:1233-40.e1. [PMID: 26282608 DOI: 10.1016/j.jtcvs.2015.07.048] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/01/2015] [Accepted: 07/15/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES During normal left ventricular (LV) filling, a vortex ring structure is formed distal to the left atrioventricular valve (LAVV). Vortex structures contribute to efficient flow organization. We aimed to investigate whether LAVV abnormality in patients with a corrected atrioventricular septal defect (AVSD) has an impact on vortex ring formation. METHODS Whole-heart 4D flow MRI was performed in 32 patients (age: 26 ± 12 years), and 30 healthy subjects (age: 25 ± 14 years). Vortex ring cores were detected at peak early (E-peak) and peak late filling (A-peak). When present, the 3-dimensional position and orientation of the vortex ring was defined, and the circularity index was calculated. Through-plane flow over the LAVV, and the vortex formation time (VFT), were quantified to analyze the relationship of vortex flow with the inflow jet. RESULTS Absence of a vortex ring during E-peak (healthy subjects 0%, vs patients 19%; P = .015), and A-peak (healthy subjects 10% vs patients 44%; P = .008) was more frequent in patients. In 4 patients, this was accompanied by a high VFT (5.1-7.8 vs 2.4 ± 0.6 in healthy subjects), and in another 2 patients with abnormal valve anatomy. In patients compared with controls, the vortex cores had a more-anterior and apical position, closer to the ventricular wall, with a more-elliptical shape and oblique orientation. The shape of the vortex core closely resembled the valve shape, and its orientation was related to the LV inflow direction. CONCLUSIONS This study quantitatively shows the influence of abnormal LAVV and LV inflow on 3D vortex ring formation during LV inflow in patients with corrected AVSD, compared with healthy subjects.
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