Background: Despite improved survival after surgical repair of atrioventricular septal defect
(AVSD) over the last decades patients are still at risk for reoperation especially
addressing left atrioventricular valve regurgitation. We analyzed our experience of
30 years to define risk factors for mortality and reoperation after AVSD repair.
Methods: Between 1986 and 2016, a total of 556 patients received AVSD repair (93% two patch
technique, 7% single patch technique). Median age was 6.0 months, 52 patients (9%)
were younger than 3 months. Median weight was 5.3 kg. Cleft closure was performed
in 97%. 56 patients received previous surgery (78% pulmonary artery banding, 21% coarctation
repair). Incidence of trisomy 21 was 60%. Associated cardiac malformations were right
ventricular outflow tract obstruction in 5%, transposition of great arteries in 2%
and heterotaxy in 0.5%. Median follow-up time was 15 years. Results were divided into
two surgical eras (1986–1999 and 2000–2016).
Results: Surgical era was found risk factor for mortality: In-hospital mortality decreased
from 10% in pre-millennium era to 4% in post-millennium era. There was also a significant
decrease in late mortality from 12% to 4%. Freedom of reoperation was 82%. Main indication
for reoperation was left ventricular valve regurgitation. 13% of these patients received
mitral valve repair, 6% mitral valve replacement. Preoperative mitral valve regurgitation
correlated with indication for mitral valve repair. 4% received reoperation for left
ventricular outflow tract obstruction and 5% for right ventricular valve regurgitation.
Reoperation rate was significantly lower in patients with trisomy 21. Pacemaker dependency
did not differ between surgical eras.
Conclusion: AVSD repair can be performed with excellent results and good long term survival.
Patients with trisomy 21 demonstrate no difference in survival but significantly lower
reoperation rates. Left atrioventricular valve regurgitation remains main indication
for reoperation.
