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Sun S, Sun Y, Huang J, Zou P, Rao J, Xu W, Liu Q. The V-shaped double-layer patch technique for complete atrioventricular septal defect: A novel surgical technique. J Thorac Cardiovasc Surg 2023; 165:1237-1243. [PMID: 35933186 DOI: 10.1016/j.jtcvs.2022.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/14/2022] [Accepted: 04/28/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Several surgical techniques for repair of a complete atrioventricular septal defect have been developed. However, the postoperative complications with these methods may lead to reoperation during follow-up. The aim of this report is to share our experience with a modified surgical technique for complete atrioventricular septal defect that has anatomic advantages postoperatively and could reduce the reoperation rate. METHODS Twenty-nine patients who underwent repair of complete atrioventricular septal defect using a V-shaped double-layer patch between April 2011 and September 2019 were retrospectively investigated. RESULTS There were no deaths (0%) and only 1 reoperation (3.4%) in the series. The aortic crossclamp and cardiopulmonary bypass times were 62.7 ± 16.0 minutes and 113.9 ± 25.9 minutes, respectively. The median follow-up duration was 5.1 years. To date, no significant residual ventricular septal defects have been detected and no left ventricular outflow tract obstruction has been seen on echocardiography in any patient. During follow-up, the left atrioventricular valve status was assessed as no incompetence in 9 patients (31.0%), trivial in 18 patients (62.1%), and mild in 2 patients (6.9%). CONCLUSIONS The V-shaped double-layer patch technique is a valuable surgical option for patients with complete atrioventricular septal defects. The midterm results in our series document excellent performance of this technique, which augments the area of the anterior valve of the left atrioventricular valve to make it closer to a normal mitral valve and may also reduce the need for reoperation.
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Affiliation(s)
- Shanquan Sun
- Cardiac Center of Guangdong Women and Children Hospital, Guangzhou, Guangdong, P.R. China.
| | - Yangxue Sun
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China
| | - Jingsi Huang
- Cardiac Center of Guangdong Women and Children Hospital, Guangzhou, Guangdong, P.R. China
| | - Peng Zou
- Cardiac Center of Guangdong Women and Children Hospital, Guangzhou, Guangdong, P.R. China
| | - Jiao Rao
- Cardiac Center of Guangdong Women and Children Hospital, Guangzhou, Guangdong, P.R. China
| | - Weibin Xu
- Cardiac Center of Guangdong Women and Children Hospital, Guangzhou, Guangdong, P.R. China
| | - Qin Liu
- Cardiac Center of Guangdong Women and Children Hospital, Guangzhou, Guangdong, P.R. China
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Li M, Li D. Modified Single-Patch Technique Versus Two-Patch Technique for the Repair of Complete Atrioventricular Septal Defect: An Updated Meta-Analysis. Pediatr Cardiol 2021; 42:463-464. [PMID: 33515327 DOI: 10.1007/s00246-021-02552-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/08/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Mengsi Li
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Dongxu Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan Province, 610041, People's Republic of China.
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Surgical Management for Complete Atrioventricular Septal Defects: A Systematic Review and Meta-Analysis. Pediatr Cardiol 2020; 41:1445-1457. [PMID: 32583199 DOI: 10.1007/s00246-020-02397-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
A meta-analysis is performed for a comparison of outcomes between the modified one-patch repair (MPR) and two-patch repair (TPR) for complete atrioventricular septal defects (CAVSD). Electronic databases, including PubMed, Scopus, Embase, and Cochrane Library were searched systematically for the literature which aimed mainly at comparing the therapeutic effects for CAVSD administrated by MPR and TPR. Corresponding data sets were extracted and two reviewers independently assessed the risks of bias. Meta-analysis was performed using Revman 5.3 and Stata 12.0. Fifteen studies meeting the inclusion criteria were included, involving 2076 subjects in total. It was observed that MPR was associated with shorter cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times, as compared with TPR. However, no statistical differences were found in terms of size of ventricular septal defects (VSD), reoperation, mortality, implantation of permanent pacemakers, and length of ventilation, hospital and intensive care unit stay. As compared with TPR, MPR is superior in terms of ACC and CPB. However, with regard to reoperation, mortality, length of ventilation, ICU and hospital stay and permanent pacemakers implantation, no significant differences are found between these two procedures. MPR is likely to apply to younger infants with faster completion of surgery. Surgery is recommended between 3 and 6 months of age.
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Bell D, Thakeria P, Betts K, Justo R, Jalali H, Wijesekera V, Venugopal P, Karl T, Alphonso N. Propensity-matched comparison of the long-term outcome of the Nunn and two-patch techniques for the repair of complete atrioventricular septal defects. Eur J Cardiothorac Surg 2019; 57:85-91. [DOI: 10.1093/ejcts/ezz124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/18/2019] [Accepted: 03/20/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
To compare the long-term performance of the Nunn and 2-patch techniques for the repair of complete atrioventricular septal defects.
METHODS
Between January 1995 and December 2015, a total of 188 patients (Nunn n = 41; 2-patch n = 147) were identified from hospital databases. Univariable Cox regression was performed to calculate the risk of reintervention in each group. Propensity score matching was used to balance the Nunn group and the 2-patch group.
RESULTS
Baseline characteristics including age at surgery, weight, trisomy 21, other cardiac anomalies, previous operations and preoperative atrioventricular valve regurgitation did not differ between the 2 groups. Overall, there was no difference in mortality between the 2 groups (P = 0.43). Duration of cardiopulmonary bypass (CPB) and myocardial ischaemia time were 29 min (P < 0.001) and 28 min (P < 0.001) longer, respectively, in the 2-patch group. Median follow-up was 10.8 years (2–21 years). Unadjusted Cox regression did not reveal a significant difference in the risk of reoperation for either group 9 years after initial surgery [hazard ratio (HR) (Nunn) 0.512, 95% confidence interval 0.176–1.49; Nunn 89%; 2-patch 82%]. This finding was reiterated from Cox regression performed on the propensity-matched sample (31 pairs). The probability of freedom from moderate or worse left atrioventricular valve regurgitation or left ventricular outflow obstruction was similar in the 2 groups.
CONCLUSIONS
The Nunn and 2-patch techniques are comparable in terms of the long-term mortality and probability of freedom from reoperation, moderate or severe left atrioventricular valve regurgitation and left ventricular outflow obstruction. However, the duration of CPB and myocardial ischaemia is longer in the 2-patch group.
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Affiliation(s)
- Douglas Bell
- University of Queensland School of Medicine, Brisbane, Australia
- The Prince Charles Hospital, Cardiothoracic Surgery, Brisbane, Australia
| | | | - Kim Betts
- Institute for Social Science Research, University of Queensland, Brisbane Australia
| | - Robert Justo
- University of Queensland School of Medicine, Brisbane, Australia
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, Brisbane, Australia
| | - Homayoun Jalali
- University of Queensland School of Medicine, Brisbane, Australia
- The Prince Charles Hospital, Cardiothoracic Surgery, Brisbane, Australia
| | | | - Prem Venugopal
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, Brisbane, Australia
| | - Tom Karl
- University of Queensland School of Medicine, Brisbane, Australia
- Johns Hopkins School of Medicine, USA
| | - Nelson Alphonso
- University of Queensland School of Medicine, Brisbane, Australia
- Queensland Paediatric Cardiac Service, Queensland Children’s Hospital, Brisbane, Australia
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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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El-Rassi I, Charafeddine F, Tabbakh A, Aboutaka M, Khater D, Arabi M, Bitar F. Surgical repair of complete atrioventricular defect (Nunn technique). Multimed Man Cardiothorac Surg 2015; 2015:mmv023. [PMID: 26443542 DOI: 10.1093/mmcts/mmv023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 08/09/2015] [Indexed: 06/05/2023]
Abstract
Two procedures have been traditionally used for the surgical repair of complete atrioventricular canal. The single-patch technique includes the division of valve leaflets, and the use of one patch to close the ventricular and the atrial septal defects, whereas the double-patch technique uses two separate patches, without the division of the bridging leaflets. Between 1997 and 2007, another technique emerged, the modified single-patch technique, or the 'Australian' technique, whereby the ventricular septal defect (VSD) is closed by the direct apposition of the bridging leaflets against the crest of the defect. Because of the absence of the ventricular septal patch, concerns have been raised about the possible left ventricular outflow tract obstruction (LVOTO), or atrioventricular valve (AVV) distortion, especially in case of a deep VSD, or if the defect extends superiorly. The results of the modified single-patch technique in terms of mortality, immediate and long-term AVV function and LVOTO have been similar to the standard techniques in most reports. This article will describe in detail the operative technique and review the relevant literature.
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Affiliation(s)
- Issam El-Rassi
- Cardiac Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Anas Tabbakh
- Cardiac Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammad Aboutaka
- Cardiac Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Daniele Khater
- Cardiac Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Cardiac Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Cardiac Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Yildirim O, Avsar M, Ozyuksel A, Akdemir M, Zeybek C, Demiroluk S, Bilal MS. Modified Single Versus Double-Patch Technique for the Repair of Complete Atrioventricular Septal Defect. J Card Surg 2015; 30:595-600. [DOI: 10.1111/jocs.12557] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ozgur Yildirim
- Department of Cardiovascular Surgery; Medicana International Hospital; Istanbul Turkey
| | - Mustafa Avsar
- Department of Cardiovascular Surgery; Medicana International Hospital; Istanbul Turkey
| | - Arda Ozyuksel
- Department of Cardiovascular Surgery; Medipol University; Istanbul Turkey
| | - Mehmet Akdemir
- Department of Anesthesiology; Medicana International Hospital; Istanbul Turkey
| | - Cenap Zeybek
- Department of Pediatric Cardiology; Medicana International Hospital; Istanbul Turkey
| | - Sener Demiroluk
- Department of Anesthesiology; Medicana International Hospital; Istanbul Turkey
| | - Mehmet Salih Bilal
- Department of Cardiovascular Surgery; Medicana International Hospital; Istanbul Turkey
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Metras D. Surgical repair of complete atrio-ventricular canal: one more approach? Eur J Cardiothorac Surg 2014; 47:525-6. [PMID: 25027269 DOI: 10.1093/ejcts/ezu235] [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: 11/14/2022] Open
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