COMPLETE ATRIOVENTRICULAR SEPTAL-DEFECTS - RESULTS OF REPAIR, RISK-FACTORS, AND FREEDOM FROM REOPERATION

Background Several perioperative risk factors influence outcomes after repair of complete atrioventricular septal defects. This study was co nducted to determine their association with perioperative mortality an d need for reoperation. Method and Results Between July 1982 and Febru ary 1995, 363 children underwent defect repair (median age, 8.3 months ; mean, 17.4 +/- 1.3). Tetralogy of Fallot was present in 21 patients, double outlet right ventricle in 4, subaortic stenosis in 8, ventricu lar hypoplasia in 8, coarctation in 5, atrial isomerism in 2, and othe r congenital anomalies in 9. Down's syndrome was present in 235 (65%). One-patch technique was applied in 99, two-patch in 243. During repai r, the anterior bridging leaflet was divided in 12, the posterior brid ging leaflet in 31, both leaflets in 71, and neither in 249. Left atri oventricular valve (LAVV) cleft was closed partially in 181 and comple tely in 112. Early mortality was 10.5%; 10-year survival, 83% (95% con fidence interval, 0.79 to 0.87). At 10 years, freedom from reoperation for LAVV repair was 86%; LAVV replacement, 90%; subaortic stenosis, 9 5%; residual ventricular septal defect, 97%; permanent pacemaker inser tion, 98%; and other types of reoperation, 95%. At the time of operati on, greater age, shorter ischemic time, absence of a double-orifice LA VV, and cleft closure were found to be significant independent predict ors of survival. Conclusions Repair of atrioventricular septal defects has acceptable early and late mortality and a low incidence of reoper ation. Double-orifice LAVV remains a risk factor. Repairs that include complete cleft closure may confer better survival.