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The effect of surgical technique, age, and Trisomy 21 on early outcome of surgical management of complete atrioventricular canal defect. Cardiol Young 2022; 32:869-873. [PMID: 34350818 DOI: 10.1017/s1047951121003139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The optimal timing, surgical technique, and the influence of Trisomy 21 on the outcome of surgical repair of Complete Atrioventricular Canal Defect remains uncertain. We reviewed our experience in the repair of CAVC to identify the influence of these factors on operative outcomes. METHODS A prospective study included 70 patients, who underwent repair of CAVC at our institute between July, 2016 and October, 2019. Primary endpoint was mortality and the secondary endpoint was a degree of left atrioventricular valve regurgitation. RESULTS No significant difference was noted between patients operated on, at the first 6 months of age versus later, regarding mortality or LAVV regurgitation. Surgical repair by modified single-patch technique showed a significant reduction in bypass time (71.13 ± 13.507 min versus 99.19 ± 27.092 min, p-value = 0.001). Compared to closure of cleft only, posterior annuloplasty used for repair of LAVV resulted in significant reduction in the occurrence of post-operative valve regurgitation during the early period (LAVV 2 + 43 versus 7 %, p-value = 0.03) and at 6 months of follow-up (LAVV 2 + 35.4 versus 0 %, p-value = 0.01), respectively. CONCLUSIONS Early intervention, in the first 6 months in patients with CAVC by surgical repair gives comparable acceptable results to later repair; Trisomy 21 was not found to be a risk factor for early intervention. Repair of common AV valve by cleft closure with posterior LAVV annuloplasty showed better results with a significant decrease in post-operative LAVV regurgitation and early mortality in comparison to the closure of cleft only.
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Kim MJ, Cha S, Baek JS, Yu JJ, Kim DH, Choi ES, Kwon BS, Yun TJ, Park CS. Contemporary outcomes after pulmonary artery banding in complete atrioventricular septal defect. Ann Thorac Surg 2022; 114:2356-2362. [PMID: 35405104 DOI: 10.1016/j.athoracsur.2022.03.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/17/2022] [Accepted: 03/22/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND This study investigated the clinical outcomes and the effect of band tightness on outcome after pulmonary artery banding (PAB) in patients with complete atrioventricular septal defect (AVSD). METHODS From 2000 through 2019, among 133 patients with isolated complete AVSD pursuing biventricular repair, 34 patients (25.6%) who underwent PAB were included in this study. Factors associated with adverse outcome, which was defined as prolonged stay in the intensive care unit (ICU) (> 10 days), were analysed using multiple logistic regression model. Receiver operating characteristic (ROC) analysis was performed to identify a threshold band tightness for adverse outcome. RESULTS The median age and weight were 43 days and 3.6kg, respectively. There were 4 early deaths. The median ICU stay was 8 days. Twenty-eight patients (28/34, 82.4%) underwent corrective surgery 10 months (IQR 7∼12 months) after PAB. In multivariable analysis, indexed band diameter was identified as a factor associated with adverse outcome (odds ratio 1.60, 95% confidence interval 1.03-2.48; p=0.035). ROC analysis indicated 22.2 mm/m2 of indexed PAB diameter measured at discharge as a threshold band tightness for adverse outcome (area under curve 0.871, p<0.001). The level of B-type natriuretic peptide similarly decreased after PAB regardless of band tightness, although the probability of worsening in atrioventricular valve regurgitation (AVVR) was significantly decreased in patients with tighter band (p=0.027). CONCLUSIONS PAB is a viable option for patients with early presenting complete AVSD. Tighter PAB might be beneficial for early postoperative outcomes and preventing progression of AVVR in complete AVSD.
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Affiliation(s)
| | | | | | | | - Dong-Hee Kim
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun Seok Choi
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bo Sang Kwon
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae-Jin Yun
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chun Soo Park
- Division of Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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3
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Common Atrioventricular Canal. CONGENIT HEART DIS 2022. [DOI: 10.1016/b978-1-56053-368-9.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Long-Term Outcome Up To 40 Years after Single Patch Repair of Complete Atrioventricular Septal Defect in Infancy or Childhood. Thorac Cardiovasc Surg 2021; 69:e68-e75. [PMID: 34953470 PMCID: PMC8751973 DOI: 10.1055/s-0041-1740070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives Patients with repaired complete atrioventricular septal defect (CAVSD)
represent an increasing portion of grown-ups with congenital heart disease. For repair of
CAVSD, the single-patch technique has been employed first. This technique requires
division of the bridging leaflets, thus, among other issues, long-term function of the
atrioventricular valves is of particular concern. Methods Between 1978 and 2001, 100 consecutive patients with isolated CAVSD
underwent single-patch repair in our institution. Hospital mortality was 11%. Primary
endpoints were clinical status, atrioventricular valve function, and freedom from
reoperation in long term. Follow-up was obtained contacting the patient and/or caregiver,
and the referring cardiologist. Results Eighty-three patients were eligible for long-term follow-up (21.0 ± 8.7,
mean ± standard deviation [21.5; 2.1–40.0, median; min–max] years after surgical repair).
Actual long-term mortality was 3.4%. Quality of life (QoL; self- or caregiver-reported in
patients with Down syndrome) was excellent or good in 81%, mild congestive heart failure
was present in 16%, moderate in 3.6% as estimated by New York Heart Association
classification. Echocardiography revealed normal systolic left ventricular function in all
cases. Regurgitation of the right atrioventricular valve was mild in 48%, mild–moderate in
3.6%, and moderate in 1.2%. The left atrioventricular valve was mildly stenotic in 15% and
mild to moderately stenotic in 2%; regurgitation was mild in 54%, mild to moderate in 13%,
and moderate in 15% of patients. Freedom from left atrioventricular-valve-related
reoperation was 95.3, 92.7, and 89.3% after 5, 10, and 30 years, respectively. Permanent
pacemaker therapy, as an immediate result of CAVSD repair ( n = 7) or as a result
of late-onset sick sinus syndrome ( n = 5), required up to six reoperations in
single patients. Freedom from pacemaker-related reoperation was 91.4, 84.4, and 51.5%
after 5, 10, and 30 years, respectively. Conclusion Up to 40 years after single-patch repair of CAVSD, clinical status and
functional results are promising, particularly, in terms of atrioventricular valve
function. Permanent pacemaker therapy results in a life-long need for surgical
reinterventions.
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Seo J, Kurosawa TA, Luis Fuentes V, Navarro-Cubas X, Bristow P, Ghez O, Brockman DJ. Surgical Management of Three Dogs with an Interatrial Communication and Atrioventricular Valve Abnormalities. CASE (PHILADELPHIA, PA.) 2021; 5:252-259. [PMID: 34430777 PMCID: PMC8370886 DOI: 10.1016/j.case.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
• Large interatrial communications in dogs are rare. • When indicated, surgical closure of an interatrial communication is possible. • When indicated, surgical repair of the atrioventricular valve is possible. • Multimodal imaging aids surgical planning in cardiac surgeries of dogs.
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Affiliation(s)
- Joonbum Seo
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Tsumugi Anne Kurosawa
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Virginia Luis Fuentes
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Xavier Navarro-Cubas
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Poppy Bristow
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
| | - Olivier Ghez
- Royal Brompton Hospital, Chelsea, London, United Kingdom
| | - Daniel J. Brockman
- Clinical Science and Services, Royal Veterinary College, Hertfordshire, United Kingdom
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Atrioventricular Septal Defects: Pathology, Imaging, and Treatment Options. Curr Cardiol Rep 2021; 23:93. [PMID: 34196822 DOI: 10.1007/s11886-021-01523-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Atrioventricular septal defects (AVSD) represent a broad spectrum of congenital anomalies from simple to the most complex heart defects including some distinct types. Clinical presentation and timing of intervention differ by morphological subset and functional anatomy. Herein, we review morphological variations and characteristics that determine appropriate intervention and provide insights into functional anatomy based on detailed three-dimensional (3D) assessment of AVSDs. RECENT FINDINGS The understanding of functional morphology of AVSDs has improved significantly with detailed 3D echocardiographic evaluation of the atrioventricular junction and valve morphology. As prenatal detection of AVSDs has increased significantly, it has become the most common fetal cardiac diagnosis enabling antenatal counseling and delivery planning. Advances in diagnosis and perioperative care have resulted in optimal outcomes. The diagnosis and management of AVSDs have improved over the years with enhanced understanding of anatomy and perioperative care resulting in optimal short and long-term outcomes.
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Diz OM, Toro R, Cesar S, Gomez O, Sarquella-Brugada G, Campuzano O. Personalized Genetic Diagnosis of Congenital Heart Defects in Newborns. J Pers Med 2021; 11:562. [PMID: 34208491 PMCID: PMC8235407 DOI: 10.3390/jpm11060562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 12/26/2022] Open
Abstract
Congenital heart disease is a group of pathologies characterized by structural malformations of the heart or great vessels. These alterations occur during the embryonic period and are the most frequently observed severe congenital malformations, the main cause of neonatal mortality due to malformation, and the second most frequent congenital malformations overall after malformations of the central nervous system. The severity of different types of congenital heart disease varies depending on the combination of associated anatomical defects. The causes of these malformations are usually considered multifactorial, but genetic variants play a key role. Currently, use of high-throughput genetic technologies allows identification of pathogenic aneuploidies, deletions/duplications of large segments, as well as rare single nucleotide variants. The high incidence of congenital heart disease as well as the associated complications makes it necessary to establish a diagnosis as early as possible to adopt the most appropriate measures in a personalized approach. In this review, we provide an exhaustive update of the genetic bases of the most frequent congenital heart diseases as well as other syndromes associated with congenital heart defects, and how genetic data can be translated to clinical practice in a personalized approach.
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Affiliation(s)
- Olga María Diz
- UGC Laboratorios, Hospital Universitario Puerta del Mar, 11009 Cadiz, Spain;
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08950 Barcelona, Spain
| | - Rocio Toro
- Medicine Department, School of Medicine, Cádiz University, 11519 Cadiz, Spain;
| | - Sergi Cesar
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain;
| | - Olga Gomez
- Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08950 Barcelona, Spain;
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), 28029 Madrid, Spain
| | - Georgia Sarquella-Brugada
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain;
- Medical Science Department, School of Medicine, University of Girona, 17003 Girona, Spain
| | - Oscar Campuzano
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08950 Barcelona, Spain
- Medical Science Department, School of Medicine, University of Girona, 17003 Girona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain
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IJsselhof RJ, Duchateau SDR, Schouten RM, Slieker MG, Hazekamp MG, Schoof PH. Long-Term Follow-Up of Pericardium for the Ventricular Component in Atrioventricular Septal Defect Repair. World J Pediatr Congenit Heart Surg 2020; 11:742-747. [PMID: 33164688 DOI: 10.1177/2150135120941461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the improved outcome in complete atrioventricular septal defect (AVSD) repair, reoperations for left atrioventricular valve (LAVV) dysfunction are common. The aim of this study was to evaluate the effect of fresh untreated autologous pericardium for ventricular septal defect (VSD) closure on atrioventricular valve function and compare the results with the use of treated bovine pericardial patch material. METHODS Clinical and echocardiographic data were collected of patients with complete AVSD with their VSD closed with either untreated autologous pericardial or treated bovine pericardial patch material between January 1, 1996, and December 31, 2003. Evaluation closed in September 2019. RESULTS A total of 77 patients were analyzed (untreated autologous pericardial VSD patch: 59 [77%], treated bovine pericardial VSD patch: 18 [23%]). Median age at surgery was 3.6 (interquartile range [IQR]: 2.7-4.5) months, and median weight was 4.5 (IQR: 3.9-5.1) kg. Trisomy 21 was present in 70 (91%) patients. Median follow-up time was 17.5 (IQR: 12.6-19.8) years. Death <30 days occurred in two (3%) patients. Reinterventions occurred in eight patients (early [within 30 days] in two, early and late in one, and late in five), all in the autologous pericardium group. Log-rank tests showed no significant difference in mortality (P = .892), LAVV reinterventions (P = .228), or LAVV regurgitation (P = .770). CONCLUSIONS In AVSD, the VSD can safely be closed with either untreated autologous pericardium or xeno-pericardium. We found no difference in LAVV regurgitation or the need for reoperation between the two patches.
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Affiliation(s)
- Rinske J IJsselhof
- Division of Pediatrics, Department of Pediatric Cardiac Surgery, 8124University Medical Center Utrecht, the Netherlands
| | - Saniyé D R Duchateau
- Division of Pediatrics, Department of Pediatric Cardiac Surgery, 8124University Medical Center Utrecht, the Netherlands
| | - Rianne M Schouten
- Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, 8125Utrecht University, the Netherlands
| | - Martijn G Slieker
- Division of Pediatrics, Department of Pediatric Cardiology, 8124University Medical Center Utrecht, the Netherlands
| | - Mark G Hazekamp
- Heart Lung Center, Department of Cardio-thoracic Surgery, 4501Leiden University Medical Center, the Netherlands
| | - Paul H Schoof
- Division of Pediatrics, Department of Pediatric Cardiac Surgery, 8124University Medical Center Utrecht, the Netherlands
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Ramgren JJ, Nozohoor S, Zindovic I, Gustafsson R, Hakacova N, Sjögren J. Long-term outcome after early repair of complete atrioventricular septal defect in young infants. J Thorac Cardiovasc Surg 2020; 161:2145-2153. [PMID: 32919770 DOI: 10.1016/j.jtcvs.2020.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The long-term outcome after repair of complete atrioventricular septal defect in young infants is still not fully understood. The objective of this study was to evaluate data after repair for complete atrioventricular septal defect over a 25-year period to assess survival and identify risk factors for left atrioventricular valve-related reoperations. METHODS A total of 304 consecutive patients underwent surgical correction for complete atrioventricular septal defect between April 1993 and October 2018. The results for young infants (aged <3 months; n = 55; mean age 1.6 ± 0.6 months) were compared with older infants (aged >3 months; n = 249; mean age, 5.1 ± 5.2 months). Mean follow-up was 13.2 ± 7.8 years (median, 14.0 years; interquartile range, 7.0-20.0). The Kaplan-Meier method was used to assess overall survival and freedom from left atrioventricular valve-related reoperation. RESULTS Overall, 30-day mortality was 1.0% (3/304) with no difference between young and older infants (P = 1.0). Overall survival in the total population at 20-year follow-up was 95.1% (±1.3%). Independent risk factors for poor survival were the presence of an additional ventricular septal defect (P = .042), previous coarctation of the aorta (P < .001), persistent left superior vena cava (P = .026), and genetic syndromes other than Trisomy 21 (P = .017). Freedom from left atrioventricular valve-related reoperation was 92.6% (±1.7%) at 20 years. There was no significant difference in left atrioventricular valve-related reoperation in young infants compared with older infants (P = .084). CONCLUSIONS Our data demonstrated that excellent long-term survival could be achieved with early repair for complete atrioventricular septal defect, and the need for reoperations due to left atrioventricular valve regurgitation was low. Primary correction in patients aged less than 3 months is, when clinically necessary, well tolerated. Palliative procedures can be avoided in the majority of patients.
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Affiliation(s)
- Jens Johansson Ramgren
- Section for Pediatric Cardiac Surgery, Department of Pediatrics, Lund University and Children's Hospital, Skane University Hospital, Lund, Sweden.
| | - Shahab Nozohoor
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skane University Hospital, Lund, Sweden
| | - Igor Zindovic
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skane University Hospital, Lund, Sweden
| | - Ronny Gustafsson
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skane University Hospital, Lund, Sweden
| | - Nina Hakacova
- Department of Pediatric Cardiology, Lund University and Children's Hospital, Skane University Hospital, Lund, Sweden
| | - Johan Sjögren
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skane University Hospital, Lund, Sweden
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"Repair of common atrioventricular junction in isolation and when associated with other congenital heart defects". Indian J Thorac Cardiovasc Surg 2020; 37:54-66. [PMID: 33584027 DOI: 10.1007/s12055-020-00947-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022] Open
Abstract
Management of atrioventricular septal defects has grown leaps and bounds since the first correction of this malformation. Main reasons considered for the improvement are good understanding of lesion anatomy, precise preoperative diagnosis including imaging, progress in surgical technique, myocardial protection, and post-operative care. In this article we review the anatomy, pathophysiology, clinical features, associations, diagnosis, surgical therapy, complications, and results of atrioventricular septal defects.
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Yoshitake S, Kaneko Y, Morita K, Hoshino M, Nagashima M, Takahashi M, Anderson RH. Reassessment of the Location of the Conduction System in Atrioventricular Septal Defect Using Phase-Contrast Computed Tomography. Semin Thorac Cardiovasc Surg 2020; 32:960-968. [PMID: 32450213 DOI: 10.1053/j.semtcvs.2020.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 11/11/2022]
Abstract
The location of the atrioventricular conduction axis in the setting of atrioventricular septal defect has previously been shown by histology and intraoperative recordings. We have now reassessed the arrangement using phase-contrast computed tomography, aiming to provide precise measurements so as to optimize future surgical repairs. We used the system based on an X-ray Talbot grating interferometer using the beamline BL20B2 in a SPring-8 synchrotron radiation facility available in Japan. We analyzed 18 specimens. The atrioventricular node was found within a nodal triangle 1.7 mm from the coronary sinus, with 95% confidence intervals from 1.45 to 2.0 millimeters. The depth of the node from the right atrial endocardium was 1.0 mm, with 95% confidence intervals from 0.73 to 1.34 mm. The overall length of the scooped-out ventricular septum was 30.8 mm, with 95% confidence intervals from 27.5 to 34.1 millimeters. The length from the inferior atrioventricular junction to the take-off of the right bundle branch was 12.8 mm, with 95% confidence intervals from 11.12 to 14.38 mm, giving a ratio of 0.43 for the extent of the axis along the inferior septum, with 95% confidence intervals of 0.38-0.48. The length of the non-branching bundle was 6.6 mm, with 95% confidence intervals from 5.57 to 7.7 mm. The proportion of septum occupied by the non-branching bundle was 0.22, with 95% confidence intervals from 0.18 to 0.26. Our findings confirm previous histological studies, extending them by providing precise measurements to guide placement of sutures during surgical repair.
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Affiliation(s)
- Shuichi Yoshitake
- Division of Cardiovascular Surgery, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatric Cardiac Surgery, University of Rochester, Rochester, New York
| | - Yukihiro Kaneko
- Division of Cardiovascular Surgery, National Center for Child Health and Development, Tokyo, Japan.
| | - Kiyozo Morita
- Department of Cardiovascular Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Masato Hoshino
- Japan Synchrotron Radiation Research Institute (SPring-8), Sayo, Hyogo, Japan
| | - Mitsugi Nagashima
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masashi Takahashi
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Robert H Anderson
- Division of Biomedical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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Dawary MA, Alshamdin FD, Alkhalaf LH, Alkhamis AO, Khouqeer FA. Outcomes of surgical repair of complete atrioventricular canal defect in patients younger than 2 years of age. Ann Saudi Med 2019; 39:422-425. [PMID: 31804135 PMCID: PMC6894453 DOI: 10.5144/0256-4947.2019.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Early surgical management of complete atrioventricular (AV) canal defect is the optimal treatment option. Since the published evidence on outcomes is inconclusive, we retrospectively studied the outcomes of patients in our institution. OBJECTIVE Study outcomes of complete AV canal repair. DESIGN Retrospective, descriptive. SETTINGS Single institute. PATIENTS AND METHODS Medical records of patients under 2 years of age who underwent complete AV canal repair from January 2004 to December 2014 were retrospectively reviewed. MAIN OUTCOME MEASURES Pre- and postoperative morbidity and mortality. SAMPLE SIZE 140 patients. RESULT The median (IQR) age at the time of surgery was 5.4 (3.9-8.2) months. Down syndrome was diagnosed in 98 (70%) of patients. AV valve regurgitation was found preoperatively in 129 (92%) and postoperatively in 135 (96%) patients. There was a significant association between preoperative pulmonary hypertension and the development of pulmonary hypertension in the postoperative period ( P=.04). Thirty-three patients needed reoperation. Arrhythmia was found in 19 patients, 16 of whom required pacemaker insertion. Seven patients died (5%). CONCLUSION The presence of preoperative and postoperative AV valve regurgitation was common in this cohort but did not significantly affect patient survival. Our findings suggest an acceptable outcome for repair of complete AV septal defect with few complications postoperatively. LIMITATION Retrospective in single institute. CONFLICT OF INTEREST None.
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Affiliation(s)
- Mohannad Ali Dawary
- From the Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Louai Hassan Alkhalaf
- From the Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Othman Alkhamis
- From the Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fareed Ahmed Khouqeer
- From the Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Complete Atrioventricular Septal Defect: Evolution of Results in a Single Center During 50 Years. Ann Thorac Surg 2019; 107:1824-1830. [DOI: 10.1016/j.athoracsur.2019.01.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/01/2019] [Accepted: 01/09/2019] [Indexed: 11/17/2022]
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''Learning curve'' in congenital cardiac surgery. Anatol J Cardiol 2019; 21:114. [PMID: 30694804 PMCID: PMC6457414 DOI: 10.14744/anatoljcardiol.2018.23355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Long-term outcomes in patients who underwent surgical correction for atrioventricular septal defect. Anatol J Cardiol 2018; 20:229-234. [PMID: 30297581 PMCID: PMC6249524 DOI: 10.14744/anatoljcardiol.2018.39660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: The follow-up results of patients operated for atrioventricular septal defect (AVSD) during 1996–2016 at Başkent University are presented. Methods: Data obtained from hospital records consists of preoperative echocardiographic and angiographic details, age and weight at surgery, operative details, Down syndrome presence, postoperative care details, early postoperative and latest echocardiographic findings and hospitalization for reintervention. Results: A total of 496 patient-files were reviewed including 314 patients (63.4%) with complete and 181 (36.6%) with partial AVSD (48.4% of all patients had Down syndrome). Atrioventricular (AV) valve morphology was Rastelli type A in 92.2%, B in 6.5%, and C in 1.3% of patients. The operative technique used was single-patch in 21.6% (108), double-patch in 25.8% (128), and modified single-patch (Wilcox) in 52.5% (260) of patients. The follow-up time was 37.79±46.70 (range, 0–198) months. A total of 64 patients (12.9%) had arrhythmias while in the intensive care unit; pacemaker was implanted in 12 patients. A total of 78 patients (15.7%) were treated for pulmonary hypertensive crisis. The early morbidity and mortality in the postoperative first month were calculated as 38% and 10%, and the late morbidity and mortality (>1 month) were calculated as 13.1% and 1.9%, respectively. The rate of reoperation in our cohort was 8.9%. Conclusion: Although the early morbidity and mortality are low in AVSD operations, the rate of reoperations for left AV valve insufficiency are still high. Although Down syndrome is not a risk factor for early mortality, the co-morbid factors, such as longer postoperative mechanical ventilator or inotropic support, lead to higher risk for morbidity. The frequency of pulmonary hypertension and consequent complications are also high.
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Mery CM, Zea-Vera R, Chacon-Portillo MA, Zhu H, Kyle WB, Adachi I, Heinle JS, Fraser CD. Contemporary Outcomes After Repair of Isolated and Complex Complete Atrioventricular Septal Defect. Ann Thorac Surg 2018; 106:1429-1437. [PMID: 30009807 DOI: 10.1016/j.athoracsur.2018.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Contemporary outcomes of complete atrioventricular septal defect (CAVSD) repair, particularly for defects with associated abnormalities, is unclear. The goal of this study is to report an all-inclusive experience of CAVSD repair using a consistent surgical approach. METHODS All patients undergoing CAVSD repair between 1995 and 2016 at our institution were included. Patients were divided into 2 groups: isolated and complex (tetralogy of Fallot, aortic arch repair, double outlet right ventricle, and total anomalous pulmonary venous return). Survival and reoperation were analyzed using log-rank test and Gray's test, respectively. Multivariable analysis was performed with Cox regression. RESULTS Overall, 406 patients underwent repair: 350 (86%) isolated and 56 (14%) complex CAVSD (tetralogy of Fallot: 34, double outlet right ventricle: 7, aortic arch repair: 12, total anomalous pulmonary venous return: 3). Median age at repair was 5 months (range, 10 days to 16 years); 339 (84%) had trisomy 21. A 2-patch repair was used in 395 (97%) and the zone of apposition was completely closed in 305 (75%). Perioperative mortality was 2% and 4% in the isolated and complex groups, respectively. Perioperative mortality since 2006 was 0.9%. Median follow-up was 7 years. Overall 10-year survival and incidence of any reoperation were 92% and 11%, respectively. Complex anatomy was not a risk factor for mortality (p = 0.35), but it was for reoperation (hazard ratio [HR]: 2.6; p < 0.01). Risk factors for left atrioventricular valve reoperation were a second bypass run (HR: 2.7) and preoperative moderate or worse regurgitation (HR: 2.3). CONCLUSIONS Mortality after CAVSD repair is low, yet reoperation remains a significant problem. Repair of complex CAVSD can be performed with similar mortality rates.
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Affiliation(s)
- Carlos M Mery
- Division of Congenital Heart Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.
| | - Rodrigo Zea-Vera
- Division of Congenital Heart Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Martin A Chacon-Portillo
- Division of Congenital Heart Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Huirong Zhu
- Outcomes and Impact Service, Texas Children's Hospital, Houston, Texas
| | - William B Kyle
- Division of Pediatric Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Iki Adachi
- Division of Congenital Heart Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Charles D Fraser
- Division of Congenital Heart Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
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Taraballi F, Sushnitha M, Tsao C, Bauza G, Liverani C, Shi A, Tasciotti E. Biomimetic Tissue Engineering: Tuning the Immune and Inflammatory Response to Implantable Biomaterials. Adv Healthc Mater 2018; 7:e1800490. [PMID: 29995315 DOI: 10.1002/adhm.201800490] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 05/31/2018] [Indexed: 12/31/2022]
Abstract
Regenerative medicine technologies rely heavily on the use of well-designed biomaterials for therapeutic applications. The success of implantable biomaterials hinges upon the ability of the chosen biomaterial to negotiate with the biological barriers in vivo. The most significant of these barriers is the immune system, which is composed of a highly coordinated organization of cells that induce an inflammatory response to the implanted biomaterial. Biomimetic platforms have emerged as novel strategies that aim to use the principle of biomimicry as a means of immunomodulation. This principle has manifested itself in the form of biomimetic scaffolds that imitate the composition and structure of biological cells and tissues. Recent work in this area has demonstrated the promising potential these technologies hold in overcoming the barrier of the immune system and, thereby, improve their overall therapeutic efficacy. In this review, a broad overview of the use of these strategies across several diseases and future avenues of research utilizing these platforms is provided.
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Affiliation(s)
- Francesca Taraballi
- Center for Biomimetic Medicine Houston Methodist Research Institute Houston TX 77030 USA
- Department of Orthopedic & Sports Medicine The Houston Methodist Hospital Houston TX 77030 USA
| | - Manuela Sushnitha
- Center for Biomimetic Medicine Houston Methodist Research Institute Houston TX 77030 USA
- Department of Bioengineering Rice University Houston TX 77005 USA
| | - Christopher Tsao
- Center for Biomimetic Medicine Houston Methodist Research Institute Houston TX 77030 USA
| | - Guillermo Bauza
- Center for Biomimetic Medicine Houston Methodist Research Institute Houston TX 77030 USA
- Center for NanoHealth Swansea University Medical School Swansea University Bay Singleton Park Wales Swansea SA2 8PP UK
| | - Chiara Liverani
- Center for Biomimetic Medicine Houston Methodist Research Institute Houston TX 77030 USA
- Biosciences Laboratory Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS Via Piero Maroncelli 40 47014 Meldola FC Italy
| | - Aaron Shi
- Center for Biomimetic Medicine Houston Methodist Research Institute Houston TX 77030 USA
- Wiess School of Natural Sciences Rice University Houston TX 77251‐1892 USA
| | - Ennio Tasciotti
- Center for Biomimetic Medicine Houston Methodist Research Institute Houston TX 77030 USA
- Department of Orthopedic & Sports Medicine The Houston Methodist Hospital Houston TX 77030 USA
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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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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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Li D, Fan Q, Iwase T, Hirata Y, An Q. Modified Single-Patch Technique Versus Two-Patch Technique for the Repair of Complete Atrioventricular Septal Defect: A Meta-Analysis. Pediatr Cardiol 2017; 38:1456-1464. [PMID: 28711966 DOI: 10.1007/s00246-017-1684-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/11/2017] [Indexed: 11/25/2022]
Abstract
Technical selection for surgical repair of complete atrioventricular septal defect (CAVSD) still remains controversial. This meta-analysis aimed to compare the modified single-patch (MP) technique with the two-patch (TP) technique for patients with CAVSD. Relevant studies comparing the MP technique with the TP technique were identified through a literature search using MEDLINE, EMBASE, Google Scholar, Cochrane Library, and the China National Knowledge Infrastructure databases. The variables were ventricular septal defect (VSD) size, cardiopulmonary bypass (CBP) time, aortic cross-clamp (ACC) time, intensive care unit stay, hospital stay, and other outcomes involving mortality, left ventricular outflow tract obstruction, atrioventricular valve regurgitation, residual septal shunt, atrioventricular block, and reoperation. A random-effect/fixed-effect model was used to summarize the estimates of mean difference/odds ratio with 95% confidence interval. Subgroup analysis stratified by region was performed. Fifteen publications involving 1034 patients were included. This meta-analysis demonstrated that (1) VSD size in the MP group was significantly smaller; (2) CBP time, ACC time, and hospital stay in the MP group experienced improvement; (3) Other postoperative outcomes showed no significant differences between two groups; and (4) The trends in China and other countries were close. The MP and TP techniques had comparable outcomes; however, the MP technique was performed with significantly shorter CBP and ACC times in patients with smaller VSDs. Given this limitation of data, the results of comparison of the two techniques in patients with larger VSDs remain unknown. Further studies are needed.
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Affiliation(s)
- Dongxu Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
- Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Qiang Fan
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Tomoyuki Iwase
- Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yasutaka Hirata
- Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Qi An
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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21
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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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Arunamata A, Balasubramanian S, Mainwaring R, Maeda K, Selamet Tierney ES. Right-Dominant Unbalanced Atrioventricular Septal Defect: Echocardiography in Surgical Decision Making. J Am Soc Echocardiogr 2016; 30:216-226. [PMID: 27939051 DOI: 10.1016/j.echo.2016.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Management of right-dominant atrioventricular septal defect (AVSD) remains a challenge given the spectrum of ventricular hypoplasia. The purpose of this study was to assess whether reported echocardiographic indices and additional measurements were associated with operative strategy in right-dominant AVSD. METHODS A blinded observer retrospectively reviewed preoperative echocardiograms of patients who underwent surgery for right-dominant AVSD (January 2000 to July 2013). Ventricular dimensions, atrioventricular valve index (AVVI; left valve area/right valve area), and right ventricular (RV)/left ventricular (RV/LV) inflow angle were measured. A second observer measured a subset of studies to assess agreement. Pearson correlation analysis was performed to examine the relationship between ventricular septal defect size (indexed to body surface area) and RV/LV inflow angle in systole. A separate validation cohort was identified using the same methodology (August 2013 to July 2016). RESULTS Of 46 patients with right-dominant AVSD (median age, 1 day; range, 0-11 months), overall survival was 76% at 7 years. Twenty-eight patients (61%) underwent single-ventricle palliation and had smaller LV dimensions and volumes, AVVIs (P = .005), and RV/LV inflow angles in systole (P = .007) compared with those who underwent biventricular operations. Three patients undergoing biventricular operations underwent transplantation or died and had lower indexed LV end-diastolic volumes compared with the remaining patients (P = .005). Interobserver agreement for the measured echocardiographic indices was good (intraclass correlation coefficient = 0.70-0.95). Ventricular septal defect size and RV/LV inflow angle in systole had a strong negative correlation (r = -0.7, P < .001). In the validation cohort (n = 12), RV/LV inflow angle in systole ≤ 114° yielded sensitivity of 100% and AVVI ≤ 0.70 yielded sensitivity of 88% for single-ventricle palliation. CONCLUSIONS Mortality remains high among patients with right-dominant AVSD. RV/LV inflow angle in systole and AVVI are reproducible measurements that may be used in conjunction with several echocardiographic parameters to support suitability for a biventricular operation in right-dominant AVSD.
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Affiliation(s)
- Alisa Arunamata
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California.
| | - Sowmya Balasubramanian
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California
| | - Richard Mainwaring
- Department of Cardiovascular Surgery, Stanford University Medical Center, Palo Alto, California
| | - Katsuhide Maeda
- Department of Cardiovascular Surgery, Stanford University Medical Center, Palo Alto, California
| | - Elif Seda Selamet Tierney
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California
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Atrioventricular septal defect: From embryonic development to long-term follow-up. Int J Cardiol 2016; 202:784-95. [DOI: 10.1016/j.ijcard.2015.09.081] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/28/2015] [Accepted: 09/23/2015] [Indexed: 11/18/2022]
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24
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Long-term outcomes after surgical repair of complete atrioventricular septal defect. J Thorac Cardiovasc Surg 2015; 150:369-74. [DOI: 10.1016/j.jtcvs.2015.05.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/31/2015] [Accepted: 05/03/2015] [Indexed: 11/18/2022]
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26
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Experiencia de 10 años en la cirugía del canal auriculoventricular. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2014.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sojak V, Kooij M, Yazdanbakhsh A, Koolbergen DR, Bruggemans EF, Hazekamp MG. A single-centre 37-year experience with reoperation after primary repair of atrioventricular septal defect. Eur J Cardiothorac Surg 2015; 49:538-44; discussion 544-5. [DOI: 10.1093/ejcts/ezv115] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/03/2015] [Indexed: 11/13/2022] Open
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Backer CL, Eltayeb O, Mongé MC, Wurlitzer KC, Hack MA, Boles LH, Sarwark AE, Costello JM, Robinson JD. Modified single patch: are we still worried about subaortic stenosis? Ann Thorac Surg 2015; 99:1671-5; discussion 1675-6. [PMID: 25825201 DOI: 10.1016/j.athoracsur.2015.01.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/31/2014] [Accepted: 01/06/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND When the modified single-patch technique for atrioventricular septal defect (AVSD) repair was introduced by Dr Benson Wilcox, there was concern that these patients might be at risk for late subaortic stenosis and left ventricular outflow tract obstruction (LVOTO). This review evaluated our modified single-patch population for LVOTO in the postoperative period. METHODS Between January 2000 and 2013, 77 infants underwent AVSD repair with a modified single-patch technique. Median age was 4.2 months, and median weight was 5 kg. Eight patients had a prior repair of coarctation of the aorta via left thoracotomy in the newborn period. RESULTS The median hospital stay was 10 days. No patient required a pacemaker. The mean and median follow-up times were 4.6 and 3.7 years, respectively. Only 2 patients (2.5%) required reoperation for LVOTO; both had prior repair of coarctation of the aorta (2 of 8 vs 0 of 69, p = 0.01). A discrete fibrous subaortic membrane developed in the first patient that required resection at 3 and 7 years after repair. The other patient had LVOTO from accessory chordae of the left atrioventricular valve and required mitral valve replacement 5 months after repair. One early death occurred at 4 months postoperatively due to liver failure related to hyperalimentation. CONCLUSIONS At intermediate term follow-up, LVOTO does not appear to be a significant postoperative issue after modified single-patch repair of AVSD. Coarctation of the aorta was the most significant predictor of late LVOTO after repair of AVSD with the modified single-patch technique.
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Affiliation(s)
- Carl L Backer
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Osama Eltayeb
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael C Mongé
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katherine C Wurlitzer
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Madelaine A Hack
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lindsay H Boles
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Anne E Sarwark
- Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - John M Costello
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joshua D Robinson
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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St Louis JD, Jodhka U, Jacobs JP, He X, Hill KD, Pasquali SK, Jacobs ML. Contemporary outcomes of complete atrioventricular septal defect repair: analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 2014; 148:2526-31. [PMID: 25125206 DOI: 10.1016/j.jtcvs.2014.05.095] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/12/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Contemporary outcomes data for complete atrioventricular septal defect (CAVSD) repair are limited. We sought to describe early outcomes of CAVSD repair across a large multicenter cohort, and explore potential associations with patient characteristics, including age, weight, and genetic syndromes. METHODS Patients in the Society of Thoracic Surgeons Congenital Heart Surgery Database having repair of CAVSD (2008-2011) were included. Preoperative, operative, and outcomes data were described. Univariate associations between patient factors and outcomes were described. RESULTS Of 2399 patients (101 centers), 78.4% had Down syndrome. Median age at surgery was 4.6 months (interquartile range, 3.5-6.1 months), with 11.8% (n = 284) aged ≤ 2.5 months. Median weight at surgery was 5.0 kg (interquartile range, 4.3-5.8 kg) with 6.3% (n = 151) < 3.5 kg. Pulmonary artery band removal at CAVSD repair was performed in 122 patients (4.6%). Major complications occurred in 9.8%, including permanent pacemaker implantation in 2.7%. Median postoperative length of stay (PLOS) was 8 days (interquartile range, 5-14 days). Overall hospital mortality was 3.0%. Weight < 3.5 kg and age ≤ 2.5 months were associated with higher mortality, longer PLOS, and increased frequency of major complications. Patients with Down syndrome had lower rates of mortality and morbidities than other patients; PLOS was similar. CONCLUSIONS In a contemporary multicenter cohort, most patients with CAVSD have repair early in the first year of life. Prior pulmonary artery band is rare. Hospital mortality is generally low, although patients at extremes of low weight and younger age have worse outcomes. Mortality and major complication rates are lower in patients with Down syndrome.
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Affiliation(s)
- James D St Louis
- Division of Pediatric Cardiac Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn.
| | - Upinder Jodhka
- Department of Pediatrics, University of Minnesota, Minneapolis, Minn
| | - Jeffrey P Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md
| | - Xia He
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Kevin D Hill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Sara K Pasquali
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Mich
| | - Marshall L Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md
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30
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Douglas WI, Doshi U. A Novel Technique for Repair of Complete Atrioventricular Canal Defect. World J Pediatr Congenit Heart Surg 2014; 5:434-9. [DOI: 10.1177/2150135114531297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/18/2014] [Indexed: 11/16/2022]
Abstract
Background: Two-patch, single-patch, and modified single-patch repairs are accepted techniques for repair of complete atrioventricular (AV) canal defects. We propose a novel, alternative technique: the central patch technique. Methods: For the central patch technique, the superior and inferior bridging leaflets are attached with simple sutures to the right and left of their coaptation point. Both bridging leaflets are incised along a line above the ventricular crest, similar to a traditional single-patch technique. An oval pericardial patch is sewn to the central defect created in the AV valve tissue. Interrupted, horizontal mattress sutures are placed along the ventricular crest, through the midline of the central patch and through the edge of the atrial septal defect (ASD) patch. Tying the sutures simultaneously closes the ventricular septal defect (VSD) and secures the ASD patch to the ventricular crest. Repair of the left AV valve and ASD closure are performed in the routine fashion. Results: Five patients underwent the central patch technique repair of complete AV canal defect. Weight was 4.8 to 6.3 kg; age was four to eight months. Cardiopulmonary bypass and myocardial times averaged 137 minutes and 109 minutes, respectively. No patient had more than mild left AV valve regurgitation or trivial residual VSD at completion of repair. No patient developed left ventricular outflow tract obstruction. Conclusion: The central patch technique is applicable to all forms of complete AV canal defect. Subjectively, it offers technical advantages compared to standard techniques and may result in a shorter learning curve for junior congenital heart surgeons. Results are preliminary but are consistent with standard techniques.
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Affiliation(s)
- William I. Douglas
- Division of Pediatric Cardiovascular Surgery, The University of Texas Medical School at Houston, Houston, TX, USA
| | - Unnati Doshi
- Division of Pediatric Cardiology, The University of Texas Medical School at Houston, Houston, TX, USA
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Prifti E, Bonacchi M, Baboci A, Giunti G, Krakulli K, Vanini V. Surgical outcome of reoperation due to left atrioventricular valve regurgitation after previous correction of complete atrioventricular septal defect. J Card Surg 2014; 28:756-63. [PMID: 24224745 DOI: 10.1111/jocs.12231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aims of this study were to evaluate the early and late outcomes in patients undergoing reoperation due to left atrioventricular valve regurgitation (LAVVR) after initial complete repair (ICR) of complete atrioventricular septal defect (CAVSD). MATERIALS AND METHOD Between January 1990 and April 2013, 45 consecutive patients underwent reoperation due to severe LAVVR. The mean age was 7.5 ± 6.2 years. Associated LAVV malformations were found in 22 (49%) patients and associated cardiac malformations in 18 (40%). The mean follow-up was 6.8 ± 2.6 years. RESULTS LAVV repair was possible in all patients. There were two hospital deaths (4.5%). Ten patients (22%) required a second reoperation due to severe LAVVR at mean 7.5 ± 8.4 months after the first reoperation. The actuarial overall survival and free-reoperation survival rates at one, three, and five years were 95.4%, 92.8%, and 92.8% and 89%, 80.5%, and 72%, respectively. Multivariate analysis revealed that the associated cardiac malformations, LAVV leaflet prolapse or detachment from the septal patch, associated LAVV malformations, and post-first correction LAVVR grade ≥ 2 were strong predictors for poor overall free-reoperation survival in patients undergoing reoperation due to LAVVR after ICR of various forms of ACVSD. CONCLUSIONS Patients with severe LAVVR post-ICR of CAVSD may undergo reoperation with acceptable postoperative mortality and morbidity; however, they are at an increased risk for developing postoperative LAVVR and subsequent reoperation.
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Affiliation(s)
- Edvin Prifti
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
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32
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Pan G, Song L, Zhou X, Zhao J. Complete Atrioventricular Septal Defect: Comparison of Modified Single-Patch Technique with Two-Patch Technique in Infants. J Card Surg 2014; 29:251-5. [PMID: 24495040 DOI: 10.1111/jocs.12295] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gaofeng Pan
- Department of Thoracic and Cardiovascular Surgery; Zhongnan Hospital of Wuhan University; Wuhan, Hubei P.R. China
| | - Laichun Song
- Department of Cardiovascular Surgery; Wuhan Asia Heart Hospital; Wuhan P.R. China
| | - Xuefeng Zhou
- Department of Thoracic and Cardiovascular Surgery; Zhongnan Hospital of Wuhan University; Wuhan, Hubei P.R. China
| | - Jinping Zhao
- Department of Thoracic and Cardiovascular Surgery; Zhongnan Hospital of Wuhan University; Wuhan, Hubei P.R. China
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33
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Sivalingam S, Krishnasamy S, Afeena Al-Fahmi N, Kong PK, Alwi M, Yakub AM. Early and midterm outcome of complete Atrioventricular Septal Defect (AVSD) in a single institution. Indian J Thorac Cardiovasc Surg 2013. [DOI: 10.1007/s12055-013-0256-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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34
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Overman DM, Baffa JM, Cohen MS, Mertens L, Gremmels DB, Jegatheeswaran A, McCrindle BW, Blackstone EH, Morell VO, Caldarone C, Williams WG, Pizarro C. Unbalanced atrioventricular septal defect: definition and decision making. World J Pediatr Congenit Heart Surg 2013; 1:91-6. [PMID: 23804728 DOI: 10.1177/2150135110363024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Unbalanced atrioventricular septal defect is an uncommon lesion with widely varying anatomic manifestations. When unbalance is severe, diagnosis and treatment is straightforward, directed toward single-ventricle palliation. Milder forms, however, pose a challenge to current diagnostic and therapeutic approaches. The transition from anatomies that are capable of sustaining biventricular physiology to those that cannot is obscure, resulting in uneven application of surgical strategy and excess mortality. Imprecise assessments of ventricular competence have dominated clinical decision making in this regard. Malalignment of the atrioventricular junction and its attendant derangement of inflow physiology is a critical factor in determining the feasibility of biventricular repair in the setting of unbalanced atrioventricular septal defect. The atrioventricular valve index accurately identifies unbalanced atrioventricular septal defect and also brings into focus a zone of transition from anatomies that can support a biventricular end state and those that cannot.
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Affiliation(s)
- David M Overman
- Division of Pediatric Cardiac Surgery, The Children's Heart Clinic, Children's Hospitals and Clinics of Minnesota, MN, USA
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35
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Harmandar B, Aydemir NA, Karaci AR, Sasmazel A, Saritas T, Bilal MS, Yekeler I. Results for Surgical Correction of Complete Atrioventricular Septal Defect: Associations with Age, Surgical Era, and Technique. J Card Surg 2012; 27:745-53. [DOI: 10.1111/jocs.12016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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36
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Kobayashi D, Delius RE, Aggarwal S. Successful replacement of common atrioventricular valve with a single mechanical prosthetic valve in an infant with repaired complete atrioventricular septal defect and methicillin-resistant Staphylococcus aureus endocarditis. CONGENIT HEART DIS 2012; 8:E134-8. [PMID: 22883625 DOI: 10.1111/j.1747-0803.2012.00698.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2012] [Indexed: 11/26/2022]
Abstract
A 4-month-old infant with trisomy 21 and repaired complete atrioventricular septal defect developed endocarditis with methicillin-resistant Staphylococcus aureus in the early postoperative period. We report the successful replacement of the common atrioventricular valve with a single St. Jude mechanical prosthetic valve, along with an intraluminal pulmonary artery banding to restrict pulmonary flow.
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Affiliation(s)
- Daisuke Kobayashi
- Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Mich, USA
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37
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Atz AM, Hawkins JA, Lu M, Cohen MS, Colan SD, Jaggers J, Lacro RV, McCrindle BW, Margossian R, Mosca RS, Sleeper LA, Minich LL. Surgical management of complete atrioventricular septal defect: associations with surgical technique, age, and trisomy 21. J Thorac Cardiovasc Surg 2011; 141:1371-9. [PMID: 21163497 PMCID: PMC3098918 DOI: 10.1016/j.jtcvs.2010.08.093] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 07/13/2010] [Accepted: 08/01/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We sought to evaluate the contemporary results after repair of a complete atrioventricular septal defect and to determine the factors associated with suboptimal outcomes. METHODS The demographic, procedural, and outcome data were obtained within 1 and 6 months after repair of a complete atrioventricular septal defect in 120 children in a multicenter observational study from June 2004 to 2006. RESULTS The median age at surgery was 3.7 months (range, 9 days to 1.1 years). The type of surgical repair was a single patch (18%), double patch (72%), and a single atrial septal defect patch with primary ventricular septal defect closure (10%). The incidence of residual septal defects and the degree of left atrioventricular valve regurgitation (LAVVR) did not differ by repair type. The median interval of intensive care stay were 4 days, ventilation use 2 days, and total hospitalization 8 days. All were independent of the presence of trisomy 21 (80% of the cohort). The in-hospital mortality rate was 2.5% (3/120). The overall 6-month mortality rate was 4% (5/120). The presence of associated anomalies and younger age at surgery were independently associated with a longer hospital stay. The age at repair was not associated with residual ventricular septal defect or moderate or greater LAVVR at 6 months. Moderate or greater LAVVR occurred in 22% at 6 months, and the strongest predictor for this was moderate or greater LAVVR at 1 month (odds ratio, 6.9; 95% confidence interval, 2.2-21.7; P < .001). CONCLUSIONS The outcomes after repair of complete atrioventricular septal defect did not differ by repair type or the presence of trisomy 21. An earlier age at surgery was associated with increased resource use but had no association with the incidence of residual ventricular septal defect or significant LAVVR.
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MESH Headings
- Age Factors
- Angiotensin-Converting Enzyme Inhibitors/therapeutic use
- Canada
- Cardiac Surgical Procedures/adverse effects
- Cardiac Surgical Procedures/mortality
- Chi-Square Distribution
- Child, Preschool
- Critical Care
- Down Syndrome/complications
- Down Syndrome/mortality
- Echocardiography, Doppler, Color
- Female
- Heart Septal Defects, Atrial/complications
- Heart Septal Defects, Atrial/diagnostic imaging
- Heart Septal Defects, Atrial/mortality
- Heart Septal Defects, Atrial/surgery
- Heart Septal Defects, Ventricular/complications
- Heart Septal Defects, Ventricular/diagnostic imaging
- Heart Septal Defects, Ventricular/mortality
- Heart Septal Defects, Ventricular/surgery
- Hospital Mortality
- Humans
- Infant
- Infant, Newborn
- Length of Stay
- Linear Models
- Logistic Models
- Male
- Odds Ratio
- Prospective Studies
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Time Factors
- Treatment Outcome
- United States
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Affiliation(s)
- Andrew M Atz
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, SC 29425, USA.
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38
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Li JS, Colan SD, Sleeper LA, Newburger JW, Pemberton VL, Atz AM, Cohen MS, Golding F, Klein GL, Lacro RV, Radojewski E, Richmond ME, Minich LL. Lessons learned from a pediatric clinical trial: the Pediatric Heart Network angiotensin-converting enzyme inhibition in mitral regurgitation study. Am Heart J 2011; 161:233-40. [PMID: 21315203 PMCID: PMC3053082 DOI: 10.1016/j.ahj.2010.10.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 10/19/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mitral regurgitation is the most common indication for reoperation in children following repair of atrioventricular septal defect (AVSD). We hypothesized that angiotensin-converting enzyme inhibitor therapy would decrease the severity of mitral regurgitation and limit left ventricular volume overload in children following AVSD repair. METHODS The Pediatric Heart Network designed a placebo-controlled randomized trial of enalapril in this population. The primary aim was to test the effect of enalapril on the change in left ventricular end-diastolic dimension body surface area-adjusted z score. Before the launch of the trial, a feasibility study was performed to estimate the number of patients with at least moderate mitral regurgitation following AVSD repair. TRIAL EXPERIENCE Seventeen months after the start of the study, 349 patients were screened, 8 were trial eligible, and only 5 were enrolled. The study was subsequently terminated because of low patient accrual. Several factors led to the problems with patient accrual, including (1) the use of criteria to assess disease severity in the feasibility study that were not identical to those used in the trial, (2) failure to achieve equipoise for the study among clinicians and referring physicians, (3) reliance on methodology developed in adult populations with different disease mechanisms, and (4) absence of adequate data to define the natural history of the disease process under study. Progress in the treatment of children with cardiovascular disease will depend on the future of multicenter collaborative clinical trials. The lessons learned from this study may contribute to improvements in this research.
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39
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Jegatheeswaran A, Pizarro C, Caldarone CA, Cohen MS, Baffa JM, Gremmels DB, Mertens L, Morell VO, Williams WG, Blackstone EH, McCrindle BW, Overman DM. Echocardiographic definition and surgical decision-making in unbalanced atrioventricular septal defect: a Congenital Heart Surgeons' Society multiinstitutional study. Circulation 2010; 122:S209-15. [PMID: 20837915 DOI: 10.1161/circulationaha.109.925636] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although identification of unbalanced atrioventricular septal defect (AVSD) is obvious when extreme, exact criteria to define the limits of unbalanced are not available. We sought to validate an atrioventricular valve index (AVVI) (left atrioventricular valve area/total atrioventricular valve area, centimeters squared) as a discriminator of balanced and unbalanced forms of complete AVSD and to characterize the association of AVVI with surgical strategies and outcomes. METHODS AND RESULTS Diagnostic echocardiograms and hospital records of 356 infants with complete AVSD at 4 Congenital Heart Surgeons' Society (CHSS) institutions (2000-2006) were reviewed and AVVI measured (n=315). Patients were classified as unbalanced if AVVI≤0.4 (right dominant) or ≥0.6 (left dominant). Surgical strategy and outcomes were examined across the range of AVVI. Competing risks analysis until the time of commitment to a surgical strategy examined 4 end states: biventricular repair (BVR), univentricular repair (UVR), pulmonary artery banding (PAB), and death before surgery. A prediction nomogram for surgical strategy based on AVVI was developed. The majority of patients had balanced AVSD (0.4<AVVI<0.6) and underwent BVR. Patients with AVVI<0.19 uniformly underwent UVR. Heterogeneous repair strategies were found when 0.19≤AVVI≤0.39 (UVR and BVR), with a disproportionate number of deaths in this range. AVVI≥0.6 (left dominant) was less common. The proportion of subjects predicted for the end states at 12 months after diagnosis are: BVR, 86%; UVR, 7%; PAB, 1%; death without surgery, 1%; alive without surgery, 5%. CONCLUSIONS AVVI effectively characterizes the transition between balanced and unbalanced AVSD with important correlation to anatomic substrate and selected surgical strategy.
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40
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Vohra HA, Chia AX, Yuen HM, Vettukattil JJ, Veldtman G, Gnanapragasam J, Roman K, Salmon AP, Haw MP. Primary Biventricular Repair of Atrioventricular Septal Defects: An Analysis of Reoperations. Ann Thorac Surg 2010; 90:830-7. [DOI: 10.1016/j.athoracsur.2010.03.108] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Revised: 03/13/2010] [Accepted: 03/16/2010] [Indexed: 10/19/2022]
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41
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Ando M, Takahashi Y. Variations of Atrioventricular Septal Defects Predisposing to Regurgitation and Stenosis. Ann Thorac Surg 2010; 90:614-21. [DOI: 10.1016/j.athoracsur.2010.03.098] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 03/08/2010] [Accepted: 03/11/2010] [Indexed: 11/25/2022]
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42
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Jonas RA, Mora B. Individualized Approach to Repair of Complete Atrioventricular Canal: Selective Use of the Traditional Single-Patch Technique Versus the Australian Technique. World J Pediatr Congenit Heart Surg 2010; 1:78-86. [DOI: 10.1177/2150135110361510] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The traditional single-patch technique for repair of complete atrioventricular (AV) canal requires surgical division of the superior and inferior common leaflets. In the neonate and young infant, subsequent resuspension of very delicate AV valve tissue on the pericardial patch can be problematic. Selective application of the modified single-patch technique as described by Nunn (Australian technique) minimizes manipulation of the AV valve leaflet tissue. Previous reports have documented that since the late 1980s, the traditional single-patch approach with leaflet resuspension is possible with a mortality of 3% or less. A review of the initial 33 patients managed with the Australian technique was undertaken. The ventricular septal defect was moderate or large in 29 patients (88%). In the balanced canal subgroup, there was no early mortality; 1 patient underwent reoperative mitral repair for cleft dehiscence 1 year postoperatively, and 1 patient with heterotaxy required pacemaker implantation. In the unbalanced canal subgroup, 2 patients died perioperatively (22%). There have been no late deaths or new left ventricular outflow tract obstruction in either subgroup. Selective application of the single-patch technique currently allows excellent results for surgical repair in the neonatal period or early infancy. Even during the learning phase of the Australian technique, satisfactory results were achieved.
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Affiliation(s)
- Richard A. Jonas
- Children’s National Heart Institute, Children’s National Medical Center, Washington DC, USA
| | - Bassem Mora
- Children’s National Heart Institute, Children’s National Medical Center, Washington DC, USA
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43
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Bakhtiary F, Takacs J, Cho MY, Razek V, Dähnert I, Doenst T, Walther T, Borger MA, Mohr FW, Kostelka M. Long-Term Results After Repair of Complete Atrioventricular Septal Defect With Two-patch Technique. Ann Thorac Surg 2010; 89:1239-43. [DOI: 10.1016/j.athoracsur.2009.11.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 11/02/2009] [Accepted: 11/03/2009] [Indexed: 11/26/2022]
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44
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Alsoufi B, Al-Halees Z, Khouqeer F, Canver CC, Siblini G, Saad E, Sallehuddin A. Results of Left Atrioventricular Valve Reoperations Following Previous Repair of Atrioventricular Septal Defects. J Card Surg 2010; 25:74-8. [DOI: 10.1111/j.1540-8191.2008.00784.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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45
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Ono M, Goerler H, Boethig D, Bertram H, Westhoff‐Bleck M, Haverich A, Breymann T. Improved Results after Repair of Complete Atrioventricular Septal Defect. J Card Surg 2009; 24:732-7. [DOI: 10.1111/j.1540-8191.2009.00912.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Masamichi Ono
- Division of Cardiothoracic, Transplantation, and Vascular Surgery
| | - Heidi Goerler
- Division of Cardiothoracic, Transplantation, and Vascular Surgery
| | - Dietmar Boethig
- Department of Pediatric Cardiology and Intensive Care Medicine
| | - Harald Bertram
- Department of Pediatric Cardiology and Intensive Care Medicine
| | | | - Axel Haverich
- Division of Cardiothoracic, Transplantation, and Vascular Surgery
| | - Thomas Breymann
- Division of Cardiothoracic, Transplantation, and Vascular Surgery
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46
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Dragulescu A, Fouilloux V, Ghez O, Fraisse A, Kreitmann B, Metras D. Complete Atrioventricular Canal Repair Under 1 Year: Rastelli One-Patch Procedure Yields Excellent Long-Term Results. Ann Thorac Surg 2008; 86:1599-604; discussion 1604-6. [DOI: 10.1016/j.athoracsur.2008.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 06/30/2008] [Accepted: 07/01/2008] [Indexed: 11/25/2022]
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47
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Halit V, Oktar GL, Imren VY, Iriz E, Erer D, Kula S, Tunaoglu FS, Gokgoz L, Olgunturk R. Traditional single patch versus the “Australian” technique for repair of complete atrioventricular canal defects. Surg Today 2008; 38:999-1003. [DOI: 10.1007/s00595-008-3786-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 01/21/2008] [Indexed: 11/30/2022]
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48
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Gaca AM, Jaggers JJ, Dudley LT, Bisset GS. Repair of Congenital Heart Disease: A Primer—Part 2. Radiology 2008; 248:44-60. [DOI: 10.1148/radiol.2481070166] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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49
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Mid-to-long term follow-up after surgical repair of atrioventricular septal defect with common atrioventricular junction and ventricular shunting associated with tetralogy of Fallot. Cardiol Young 2008; 18:100-4. [PMID: 18197999 DOI: 10.1017/s1047951107001874] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Our aim is to describe our surgical approach in dealing with patients having atrioventricular septal defect with common atrioventricular junction and ventricular shunting associated with tetralogy of Fallot over the last 8 years, and to present our results in mid-to-long term follow-up. METHODS Between November 1995 and January 2004, we performed surgical correction in 8 consecutive children with atrioventricular septal defect, common atrioventricular junction, interventricular shunting, and associated tetralogy of Fallot. The age at surgical correction varied from 8 months to 20 years, with a mean of 45 months, and standard deviation of 74 months. A palliative systemic-to-pulmonary shunt had previously been performed in 3 patients. Follow-up ranged from 57 to 135 months, with a mean of 93.5 months, and standard deviation of 32 months. We used a two-patch technique to repair of the atrioventricular septal defect, and a pericardial transjunctional patch for relief of the obstruction in the right ventricular outflow tract. RESULTS There were no deaths, nor reoperations either in the postoperative period or during follow-up. All patients are asymptomatic, or in the second class created by the New York Heart Association. The mean period of cardiopulmonary by-pass was 136 minutes, and the mean stay in hospital was 11.8 days. At the last examination, pulmonary valvar insufficiency was considered severe in 2 patients, and moderate in another 2. No patient developed more than a trace of regurgitation across the reconstituted left atrioventricular valve. CONCLUSIONS The two-patch technique, associated with ventriculotomy and a transjunctional pulmonary patch is safe and efficient when correcting atrioventricular septal defect associated with tetralogy of Fallot, resulting in good mid-to-long term clinical outcomes.
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50
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Rasiah SV, Ewer AK, Miller P, Wright JG, Tonks A, Kilby MD. Outcome following prenatal diagnosis of complete atrioventricular septal defect. Prenat Diagn 2008; 28:95-101. [DOI: 10.1002/pd.1922] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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