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Wang B, Verrocchi J, Liew D, Zentner D. Does Down syndrome influence the outcomes of congenital cardiac surgery? A systematic review and meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:240-248. [PMID: 35612980 DOI: 10.1093/ehjqcco/qcac028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Congenital cardiac surgery for individuals with Down syndrome (DS) has historically occurred at a reduced frequency. Little data are available regarding long-term post-congenital cardiac surgical outcomes. Limited sample sizes and clinical heterogeneity require a pooled analysis approach. AIMS To compare long-term outcomes post-congenital heart surgery between adults with and without DS. METHODS Databases (Medline, Embase, and PubMed) were searched utilizing terms related to DS and congenital heart disease.Studies that enrolled adults (>18 years) with operated congenital heart disease and compared long-term outcomes with respect to DS presence were included. All study designs were included, but those with limited/peri-operative follow-up, non-English texts, case studies, and literature reviews were excluded.Blinded screening, data extraction, and quality assessment were independently conducted by two reviewers. QUIPS criteria were used for risk of bias analysis. Both random- and fixed-effects models were used for meta-analysis. RESULTS A total of 23 studies (n = 10 466) were included. Risk of bias was frequently high due to unblinded retrospective study designs and analyses limited in adjustment for other prognostic factors.Meta-analysis demonstrated no effect of DS on long-term mortality [hazard ratio (HR) 0.86, 95% confidence interval (95% CI) 0.6-1.23], to a maximum described follow-up of 38 years. Lower cardiac reoperation risk (HR 0.6, 95% CI 0.46-0.78) for individuals with DS was found on pooled analysis. Meta-analysis was limited by between-study variation. CONCLUSION DS does not affect post-congenital cardiac surgical survival in adulthood. Reduced reoperation may reflect challenges in assessing functional and symptomatic status and/or concerns regarding perceived reoperation difficulties or likely benefits.
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Affiliation(s)
- Benjamen Wang
- Cardiology Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
| | - Justin Verrocchi
- Monash Medical Centre, Monash Health, Clayton, VIC 3168, Australia
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Dominica Zentner
- Cardiology Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
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Nakayama Y, Shinkawa T, Hoki R, Kobayashi K, Yoshida H, Sato Y, Niinami H. Surgical Outcomes in Children With Partial and Transitional Atrioventricular Septal Defect. World J Pediatr Congenit Heart Surg 2022; 13:451-457. [PMID: 35757952 DOI: 10.1177/21501351221100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study aimed to evaluate the long-term outcomes of partial and transitional atrioventricular septal defect repair, focusing on left atrioventricular valve reoperation. METHODS We conducted a retrospective review of 104 children who underwent partial or transitional atrioventricular septal defect repair between August 1983 and January 2021. The major outcomes included patient survival and left atrioventricular valve reoperation. RESULTS Median age at repair was 4.0 (0.1-17.0) years, with 17 patients being infants (age ≤ 1 year; 16.3%). All but eight patients (92.3%) underwent left atrioventricular valve cleft closure. After initial repair, there were 18 cases of moderate-to-severe left atrioventricular valve regurgitation (17.3%). Three in-hospital deaths (2.9%) and four late deaths (3.8%) occurred. At follow-up (median 14.3 years), actuarial survival was 95.1% and 93.0% at 1 and 20 years, respectively, and 16 patients (15.4%) had undergone a total of 19 left atrioventricular valve reoperations. Initial repair performed during infancy was associated with significantly higher mortality than a repair performed after infancy (35.3% vs 1.5%, P < .01, hazard ratio = 26.4). On multivariable analysis, repair during infancy was associated with mortality (P < .01, hazard ratio = 27.4, 95% confidence interval = 2.7-283). Partial or no cleft closure of left atrioventricular valve (P = .03, hazard ratio = 4.7, 95% confidence interval = 1.2-18.8) and moderate-to-severe left atrioventricular valve regurgitation after repair (P < .01, hazard ratio = 9.9, 95% confidence interval = 3.0-32.2) were associated with left atrioventricular valve reoperation. CONCLUSIONS Partial and transitional atrioventricular septal defect repair outcomes were generally satisfactory. However, repair during infancy had worse survival outcomes, and moderate-to-severe left atrioventricular valve regurgitation after a repair was associated with future left atrioventricular valve reoperation.
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Affiliation(s)
- Yuki Nakayama
- Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo, Japan
| | - Takeshi Shinkawa
- Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo, Japan
| | - Ryogo Hoki
- Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo, Japan
| | - Kei Kobayashi
- Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo, Japan
| | - Hisashi Yoshida
- Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo, Japan
| | - Yasuto Sato
- Department of Public Health, 13131Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo, Japan
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Buratto E, Lui A, Hu T, Naimo P, Ivanov Y, d'Udekem Y, Brizard CP, Konstantinov IE. Propensity score matched analysis of cleft closure in complete atrioventricular septal defect repair. Ann Thorac Surg 2021; 113:1553-1561. [PMID: 34487709 DOI: 10.1016/j.athoracsur.2021.07.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/02/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Repair of complete atrioventricular septal defect (cAVSD) is achieved with low mortality. However, there is a high rate of reoperation on the left atrioventricular valve (LAVV), which is often attributed to non-closure of the cleft. Although non-closure of the cleft has been reported to be a risk factor for reoperation, no randomized-controlled or propensity-matched trials have ever been performed. We investigated the effect of cleft closure on outcomes following cAVSD repair. METHODS We reviewed 455 patients who underwent cAVSD repair between 1990 and 2019. To determine the effect of cleft closure, propensity score matching was performed on risk factors for reoperation following cAVSD repair. RESULTS Median age was 3.6 months (mean 9.6±20.4), median weight was 4.3 kg (mean 4.7±4.3kg) and 41.9% (191/455) were male. Early mortality was 2.9% (13/455), and survival was 89.8±1.9% at 20 years. Early reoperation was a risk factor for mortality (p=0.004). Freedom from reoperation was 72.5±4.0% at 20 years. Freedom from LAVV reoperation was 74.1±4.0% at 20 years. Preoperative severe LAVV regurgitation (p<0.001) and early postoperative moderate or greater LAVV regurgitation (p=0.007) were risk factors for reoperation, while trisomy 21 (p=0.03) and recent era of surgery (p=0.02) were protective. Propensity score matching yielded 106 pairs. There were no differences in long-term survival (p=0.71) or reoperation (p=0.26) between the two groups. CONCLUSIONS Repair of cAVSD can be achieved with low mortality and good long-term survival, however, the reoperation rate remains high. Similar freedom from reoperation can be achieved with or without closure of the LAVV cleft.
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Affiliation(s)
- Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne
| | - Adrienne Lui
- Department of Paediatrics, University of Melbourne, Melbourne
| | - Thomas Hu
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne
| | - Phillip Naimo
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne
| | - Yaroslav Ivanov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne.
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Early repair of complete atrioventricular septal defect has better survival than staged repair after pulmonary artery banding: A propensity score–matched study. J Thorac Cardiovasc Surg 2021; 161:1594-1601. [DOI: 10.1016/j.jtcvs.2020.07.106] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/13/2020] [Accepted: 07/31/2020] [Indexed: 11/23/2022]
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Single-ventricle palliation in children with atrioventricular septal defect and transposition of the great arteries: 45 years of experience. Cardiol Young 2020; 30:1165-1170. [PMID: 32594938 DOI: 10.1017/s1047951120001791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The association of atrioventricular septal defect and transposition of the great arteries is very rare. As a rule, these patients have unbalanced ventricles. However, there have been no studies describing the results of single-ventricle palliation in these children. METHODS All children who underwent surgery with a diagnosis of atrioventricular septal defect and transposition of the great arteries were included in the study. Data were obtained from medical records. RESULTS A total of 38 patients with atrioventricular septal defect and transposition of the great arteries underwent single-ventricle palliation at the study institution between 1971 and 2016. The mean follow-up was 12.4 years (median: 14.6 years, range 2-43.3 years). Most children had unbalanced atrioventricular septal defect (94.7%, 36/38). Survival was 67.6% (95% confidence interval [CI]: 50.0-80.2%) at 10 years and 57.8% (95% CI: 38.0-73.4%) at 20 years. By 10 years, 58.6% (95% CI: 40.8-72.7%) had progressed to Fontan completion, while 32.5% (95% CI: 18.2-47.6%) had died. In patients achieving Fontan completion, 20-year event-free survival was 73.3% (95% CI: 34.8-91.3%), while 5.0% (95% CI: 0.4-20.5%) had undergone cardiac transplantation and 21.7% (95% CI: 3.2-50.8%) had undergone takedown of the Fontan circulation. Freedom from atrioventricular valve surgery was 57.0% (95% CI: 37.2-72.7%) at 10 and 20 years. CONCLUSIONS The association of atrioventricular septal defect and transposition of the great arteries is very rare, and most of these children have unbalanced ventricles. Single-ventricle palliation results in 25-year overall survival of 50%. However, in patients, who had Fontan completion, survival was 75% at 25 years after Fontan operation.
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Song L, Ling Y, An Q. Repair of partial atrioventricular canal defect in adult patients: two-year follow-up outcomes of a retrospective study. J Cardiothorac Surg 2019; 14:106. [PMID: 31186038 PMCID: PMC6560765 DOI: 10.1186/s13019-019-0931-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/03/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Partial atrioventricular canal defects (PAVC) are preferred to be repaired when diagnosed and before an operation would interfere with school. There were rare previous studies about partial atrioventricular canal defect operations in adult patients. In this single-center retrospective study, we mean to review the mid-term follow-up outcomes of late diagnosed and repaired partial atrioventricular canal defects in adult patients. METHODS 46 adult partial atrioventricular canal defect patients who underwent operation in West China Medical Center from 2009 to 2017 were included. Required data were obtained from operation notes, patient charts and the outpatient records. RESULTS Among 46 patients, 10(21.7%)were male and mean age at operation was 37.6 ± 12.4 years. 11 patients had prior arrythmia, including 8 atrial fibrillations, 2 atrioventricular blocks and 1 left bundle branch block. There were 41 patients with tricuspid valve regurgitation and 22 underwent tricuspid valvuloplasty. All the patients had mitral regurgitation. 6 patients with valve incrassation and shrinkage underwent mitral valve replacement, and the rest underwent mitral repair surgery. There was one early death post operation and no more mortalities in the following follow-up years. According to the follow-up outcomes, heart function of the patients recovered significantly, dilation of atriums and ventricles, except for left atriums, were reversed to a large extent and all but one patients' tricuspid valve regurgitations were reduced to mild and below. 4(8.7%) patients underwent reoperation and the main reasons were arrythmia and recurrent severe mitral valve regurgitation. CONCLUSION Partial atrioventricular canal defect repair in adult patients can achieve good results. Compared with the results of patients underwent operations in preschool years, though delayed surgery timing seems to bring more preoperative complications and influences heart function, the mortality and reoperation rate are excellent.
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Affiliation(s)
- Lingyun Song
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan 610041 People’s Republic of China
| | - Yunfei Ling
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan 610041 People’s Republic of China
| | - Qi An
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan 610041 People’s Republic of China
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Abstract
PURPOSE OF REVIEW In the last 40 years, with a better understanding of cardiac defects, and with the improved results of cardiac surgery, the life expectancy of persons with Down syndrome has significantly increased. This review article reports on advances in knowledge of cardiac defects and cardiovascular system of persons with trisomy 21. RECENT FINDINGS New insights into the genetics of this syndrome have improved our understanding of the pathogenetic mechanisms of cardiac defects. Recent changes in neonatal prevalence of Down syndrome suggest a growing number of children with cardiac malformations, in particular with simple types of defects. Ethnic and sex differences of the prevalence of specific types of congenital heart disease (CHD) have also been underlined. A recent study confirmed that subclinical morphologic anomalies are present in children with trisomy 21, also in the absence of cardiac defects, representing an internal stigma of Down syndrome. The results of cardiac surgery are significantly improved in terms of immediate and long-term outcomes, but specific treatments are indicated in relation to pulmonary hypertension. Particular aspects of the cardiovascular system have been described, clarifying a reduced sympathetic response to stress but also a 'protection' from atherosclerosis and arterial hypertension in these patients. SUMMARY Continuing dedication to clinical and basic research studies is essential to further improve survival and the quality of life from childhood to adulthood of patients with trisomy 21.
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Affiliation(s)
| | | | - Maria C Digilio
- Genetics and Rare Diseases Research Division, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Bruno Marino
- Department of Pediatrics, Sapienza University of Rome
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Konstantinov IE, Buratto E. Repair of partial atrioventricular septal defects in infancy: a paradigm shift or a road block? Heart 2018; 104:1388-1389. [PMID: 29472292 DOI: 10.1136/heartjnl-2017-312817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Igor E Konstantinov
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Edward Buratto
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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