1
|
Ozturk M, Tongut A, Sterzbecher V, Desai M, Esmailian G, Henmi S, Spurney C, Staffa SJ, d’Udekem Y, Yerebakan C. Repair of the complete atrioventricular septal defect-impact of postoperative moderate or more regurgitation. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae053. [PMID: 38569897 PMCID: PMC11055535 DOI: 10.1093/icvts/ivae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/22/2023] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES To study the risk factors for mortality, moderate or more left atrioventricular valve regurgitation (LAVVR) and reoperation after the surgical repair of complete atrioventricular septal defect (cAVSD) in a single centre. METHODS The current study is a retrospective review of patients who underwent surgical repair of cAVSD between 2000 and 2021. Patients with unbalanced ventricles not amenable to biventricular repair, double outlet right ventricle and malpositioned great arteries were excluded. The clinical predictors of outcome for end points were analysed with univariate and multivariable Cox regression analysis or Fine-Gray modelling for competing risks. Time-dependent end points were estimated using the Kaplan-Meier curve analysis and cumulative incidence curves. RESULTS The median follow-up time was 2.3 years. Among 220 consecutive patients were 10 (4.6%) operative and 21 late mortalities (9.6%). A total of 26 patients were identified to have immediate postoperative moderate or more regurgitation and 10 of them ultimately died. By multivariable analysis prematurity and having more than moderate regurgitation immediately after the operation were identified as predictors of overall mortality (P = 0.003, P = 0.012). Five- and ten-year survival rates were lower for patients with immediate postoperative moderate or more LAVVR {51.9% [confidence interval (CI): 27.5-71.7%]} when compared to patients without moderate or more regurgitation [93.2% (CI: 87.1-96.4%) and 91.3% (CI: 83.6-95.5%)]. CONCLUSIONS The patients who undergo cAVSD repair remain subjected to a heavy burden of disease related to postoperative residual LAVVR. Immediate postoperative moderate or more LAVVR contributes significantly to overall mortality. Whether a second run of bypass can decrease this observed mortality should be investigated.
Collapse
Affiliation(s)
- Mahmut Ozturk
- Division of Cardiac Surgery, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Aybala Tongut
- Division of Cardiac Surgery, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Vanessa Sterzbecher
- Division of Cardiac Surgery, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Manan Desai
- Division of Cardiac Surgery, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Gabriel Esmailian
- Division of Cardiac Surgery, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Soichiro Henmi
- Division of Cardiac Surgery, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Christopher Spurney
- Division of Cardiology, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yves d’Udekem
- Division of Cardiac Surgery, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Can Yerebakan
- Division of Cardiac Surgery, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| |
Collapse
|
2
|
Afifi ARSA, Seale AN, Chaudhari M, Khan NE, Jones TJ, Stumper O, Botha P. Pulmonary artery banding: still a role for staged bi-ventricular repair of intracardiac shunts? Cardiol Young 2023; 33:1627-1633. [PMID: 36102125 DOI: 10.1017/s1047951122002918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Although pulmonary artery banding remains a useful palliation in bi-ventricular shunting lesions, single-stage repair holds several advantages. We investigate outcomes of the former approach in high-risk patients. METHODS Retrospective cohort study including all pulmonary artery banding procedures over 9 years, excluding single ventricle physiology and left ventricular training. RESULTS Banding was performed in 125 patients at a median age of 41 days (2-294) and weight of 3.4 kg (1.8-7.32). Staged repair was undertaken for significant co-morbidity in 81 (64.8%) and anatomical complexity in 44 (35.2%). The median hospital stay was 14 days (interquartile range 8-33.5) and 14 patients (11.2%) required anatomical repair before discharge. Nine patients died during the initial admission (hospital mortality 7.2 %) and five following discharge (inter-stage mortality 4.8%). Of 105 banded patients who survived, 19 (18.1%) needed inter-stage re-admission and 18 (14.4%) required unplanned re-intervention. Full repair was performed in 93 (74.4%) at a median age of 13 months (3.1-49.9) and weight of 8.5 kg (3.08-16.8). Prior banding, 54% were below the 0.4th weight centile, but only 28% remained so at repair. Post-repair, 5/93 (5.4%) developed heart block requiring permanent pacemaker, and 11/93 (11.8%) required unplanned re-intervention. The post-repair mortality (including repairs during the initial admission) was 6/93 (6.5%), with overall mortality of the staged approach 13.6% (17/125). CONCLUSIONS In a cohort with a high incidence of co-morbidity, pulmonary artery banding is associated with a significant risk of re-intervention and mortality. Weight gain improves after banding, but heart block, re-intervention, and mortality remain frequent following repair.
Collapse
Affiliation(s)
- Ahmed R S A Afifi
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, BirminghamB4 6NH, UK
- Department of Pediatrics, Faculty of Medicine, Benha University, Benha 13512, Egypt
| | - Anna N Seale
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, BirminghamB4 6NH, UK
| | - Milind Chaudhari
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, BirminghamB4 6NH, UK
| | - Natasha E Khan
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, BirminghamB4 6NH, UK
| | - Timothy J Jones
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, BirminghamB4 6NH, UK
| | - Oliver Stumper
- Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, BirminghamB4 6NH, UK
| | - Phil Botha
- Department of Cardiac Surgery, Birmingham Women's and Children's NHS Foundation Trust, BirminghamB4 6NH, UK
| |
Collapse
|
3
|
Schumacher K, Marin Cuartas M, Meier S, Aydin MI, Borger MA, Dähnert I, Kostelka M, Vollroth M. Long-term results following atrioventricular septal defect repair. J Cardiothorac Surg 2023; 18:250. [PMID: 37612667 PMCID: PMC10463950 DOI: 10.1186/s13019-023-02355-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Atrioventricular septal defects (AVSD) represent 4-7% of congenital cardiac malformations. Definitive early repair is favored over prior pulmonary artery banding and delayed definitive repair in many centers. The aim of this study was to analyze long-term outcomes following AVSD repair over a 21-year period. METHODS A total of 202 consecutive patients underwent surgical AVSD correction between June 1999 and December 2020. Surgery was performed using the double-patch technique. The study data were prospectively collected and retrospectively analyzed. Primary outcomes were In-hospital mortality and overall long-term freedom from reoperation. RESULTS Median age at operation was 120 days (IQR 94-150), median weight was 5.0 kg (4.2-5.3). None of the patients died within the first 30 postoperative days. In-hospital mortality was 0.5% (1/202 patients). Median follow-up was 57 months (11-121). Overall freedom from reoperation at 5, 10 and 15 years was 91.8%, 86.9% and 86.9%, respectively. CONCLUSION AVSD repair with the double-patch technique is a safe and effective procedure with good early postoperative outcomes and low long-term reoperation rates.
Collapse
Affiliation(s)
- Katja Schumacher
- Department of Cardiac Surgery, University, Leipzig Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany
| | - Mateo Marin Cuartas
- Department of Cardiac Surgery, University, Leipzig Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany
| | - Sabine Meier
- Department of Cardiac Surgery, University, Leipzig Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany
| | - Muhammed Ikbal Aydin
- Department of Cardiac Surgery, University, Leipzig Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany
| | - Michael Andrew Borger
- Department of Cardiac Surgery, University, Leipzig Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany
| | - Ingo Dähnert
- Department of Pediatric Cardiology, Leipzig Heart Center, Leipzig, Germany
| | - Martin Kostelka
- Department of Cardiac Surgery, University, Leipzig Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany
| | - Marcel Vollroth
- Department of Cardiac Surgery, University, Leipzig Heart Center, Strümpellstrasse 39, 04289, Leipzig, Germany.
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Basgoze S, Yildiz O, Ozturk E, Onan IS. Repair of complete atrioventricular canal defects: Early and midterm results and comparison of the left anterior leaflet augmentation technique with traditional technics. J Card Surg 2021; 36:2658-2668. [PMID: 33955056 DOI: 10.1111/jocs.15602] [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: 04/02/2021] [Accepted: 04/19/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Complete atrioventricular septal defects (CAVSD) include a variable spectrum of congenital malformations with different forms of clinical findings. We examined early and midterm outcomes, the need for reoperation, postoperative residual AV valve regurgitation, and other risk factors after various CAVSD repairs. METHODS Between 2014 and 2018, we have performed 89 isolated CAVSD repairs. We retrospectively reviewed the patients' medical records. Patients were divided into three groups according to their repair techniques modified one patch repair (MP) (n = 16); two patch repair (TP) (n = 49); and left anterior leaflet augmentation (ALA) technique (n = 24). RESULTS Eighty patients (89.8%) survived hospital discharge. Early mortality rates were three (18.8%) in the group MP, five (10.2%) in the group TP, and one (4.2%) in the group ALA. Thirteen patients died during the follow-up period. Late mortality rates were three (18.8%) in the group MP, four (16.6%) in the group ALA, and six (12.2%) in the group TP. The mean follow-up time was 35.9 ± 22.97 months (range: 0.3-77 months). The morbidity and mortality results were similar between-group TP and ALA but worse in the MP group. Low body weight (<4 kg) and younger age at surgery (<4 months) were found to be risk factors on mortality by univariate and multivariate analysis. Surgical technic was not found to be an independent risk factor. CONCLUSION In our series, TP and ALA techniques had satisfactory results in early and midterm periods. Younger age and small bodyweight might increase early mortality and the need for reoperation.
Collapse
Affiliation(s)
- Serdar Basgoze
- Department of Cardiovascular Surgery, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Okan Yildiz
- Department of Pediatric Cardiovascular Surgery, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Erkut Ozturk
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ismihan Selen Onan
- Department of Pediatric Cardiovascular Surgery, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
6
|
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.
Collapse
|