Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-20T13:36:19.223Z Has data issue: false hasContentIssue false

What is the optimal time to repair atrioventricular septal defect and common atrioventricular valvar orifice?

Published online by Cambridge University Press:  18 June 2007

Brian E. Kogon*
Affiliation:
Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, United States of America
Hunter Butler
Affiliation:
Sibley Heart Center Cardiology, Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
Michael McConnell
Affiliation:
Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
Traci Leong
Affiliation:
Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, United States of America
Paul M. Kirshbom
Affiliation:
Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, United States of America
Kirk R. Kanter
Affiliation:
Department of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, United States of America
*
Correspondence to: Brian E. Kogon, MD, Emory University, Children’s Healthcare of Atlanta, Egleston, Atlanta, GA – 30322, USA. Tel: +404 785 6319; Fax: +404 785 6266; E-mail: Brian_kogon@emoryhealthcare.org

Abstract

Objective

With improvements in technology and surgical technique, paediatric cardiologists are challenging surgeons to repair balanced atrioventricular septal defects in smaller patients. Early repair minimizes aggressive medical therapy to prevent heart failure, maintains growth, and limits exposure to elevated pulmonary pressures. We compare the outcomes of repair among different-sized children.

Methods

From December 2002 to July 2005, 92 patients underwent repair of an atrioventricular septal defect with common atrioventricular valvar orifice and balanced ventricles. We reviewed operative and postoperative data. We excluded patients weighing more than 10 kilograms, but included those who underwent concomitant closure of a patent oval foramen or atrial septal defect, or ligation of a patent arterial duct. Those requiring other concomitant procedures were excluded from the analysis.

Results

The median weight at repair was 4.9 kilograms, with a range from 2.93 to 7.9 kilograms, and the median age was 5.1 months, with a range from 0.39 to 9.6 months. Operative data included the time required for cardiopulmonary bypass, aortic cross-clamping, and the overall procedure. These times were not significantly affected by decreasing weight. Postoperative continuous data included duration of ventilation and length of intensive care unit and hospital stay. Stay in intensive care (p = 0.006) and hospital (p = 0.007) both increased significantly with decreasing weight. Postoperative categorical data included presence of residual ventricular septal defects, regurgitation across the left atrioventricular valve, and complications. While there was no difference in residual defects (p = 0.166) or valvar regurgitation (p = 0.729), there was a significantly higher presence of complications with decreasing weight (p = 0.0043). There was no mortality, and no persistent heart block requiring placement of a permanent pacemaker.

Conclusions

Our data shows that, with the exception of a slightly longer and more complicated postoperative course, early surgery for symptomatic patients with atrioventricular septal defects and common atrioventricular valvar orifice can be undertaken safely and effectively in smaller children with excellent outcomes.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Castaneda, A, Jonas, R, Mayer, J. Cardiac Surgery in the Neonate and Infant. Saunders, Philadelphia, 1994.Google Scholar
2 Chin, A, Keane, J, Norwood, W, Castaneda, A. Repair of complete common atrioventricular canal in infancy. J Thorac Cardiovasc Surg 1982; 84: 437445.CrossRefGoogle ScholarPubMed
3. Matsuda, H, Hirose, H, Nakano, S, et al. . Postoperative changes of pulmonary vascular resistance in patients with complete atrioventricular canal defect: relation to age at primary repair. Jpn Circ J 1984; 48: 10811086.CrossRefGoogle ScholarPubMed
4. Yasui, H, Nakamura, Y, Kado, H, et al. . Primary repair of complete atrioventricular canal: recommendation for early primary repair. J Cardiovasc Surg 1990; 31: 498504.Google ScholarPubMed
5. Yamaki, S, Yasui, H, Kado, H, et al. . Pulmonary vascular disease and operative indications in complete atrioventricular canal defect in early infancy. J Thorac Cardiovasc Surg 1993; 106: 398405.CrossRefGoogle ScholarPubMed
6. Malec, E, Mrozcek, T, Pajak, J, Januszewska, K, Zdebska, E. Results of surgical treatment of congenital heart defects in children with Down’s syndrome. Pediatr Cardiol 1999; 20: 351354.CrossRefGoogle ScholarPubMed
7. Michielon, G, Stellin, G, Rizzoli, G, Casarotto, D. Repair of complete common atrioventricular canal defects in patients younger than four months of age. Circulation 1997; 96: II316II322.Google ScholarPubMed
8. Studer, M, Blackstone, EH, Kirklin, JW, et al. . Determinants of early and late results of repair of atrioventricular septal (canal) defects. J Thorac Cardiovasc Surg 1982; 84: 523542.CrossRefGoogle ScholarPubMed
9. Jonas, R. Comprehensive Surgical Management of Congenital Heart Disease 2004. Arnold Publishing, London, 2004.Google Scholar
10. Mavroudis, C, Backer, C, Jacobs, J. Ventricular septal defect. In: Mavroudis, C, Backer, C (eds). Pediatric cardiac surgery. Mosby, Philadelphia, 2003, pp 298320.Google Scholar
11. Buchhorn, R, Bartmus, D, Siekmeyer, W, Hulpke-Wette, M, Schulz, R, Bursch, J. Beta-blocker therapy of severe congestive heart failure in infants with left to right shunts. Am J Cardiol 1998; 81: 13661368.CrossRefGoogle ScholarPubMed
12. Shaw, NJ, Wilson, N, Dickenson, DF. Captopril in heart failure secondary to left to right shunt. Arch Dis Child 1987; 62: 11361138.Google Scholar
13. Hanley, FL, Fenton, KN, Jonas, RA, et al. . Surgical repair of complete atrioventricular canal defects in infancy: twenty year trends. J Thorac Cardiovasc Surg 1993; 106: 387394.CrossRefGoogle ScholarPubMed
14. Kopf, G, Mello, D. Surgery for congenital heart disease in low-birth weight neonates: a comprehensive statewide Connecticut program to improve outcomes. Conn Med 2003; 67: 327332.Google ScholarPubMed