REPAIR OF COMPLETE COMMON ATRIOVENTRICULAR-CANAL DEFECTS IN PATIENTS YOUNGER THAN 4 MONTHS OF AGE

Background The purpose of this study was to evaluate the impact of age at repair and atrioventricular (AV) valve anatomy on preoperative and postoperative AV valve incompetence (AVVR) was done to test the hypot hesis that early repair (less than 4 months of life) can be safely acc omplished and not only control heart failure but also improve surgical results on AV valve reconstruction. Methods and Results One hundred p atients, median age 6.1 months, underwent repair of the complete commo n AV canal defect (CAVC) between 1981 and 1996. Surgery was performed in 37 patients (37%) less than 4 months of age (Group 1) and in 63 pat ients (63%) more than 4 months of age (Group 2). Surgical correction i ncluded double patch septal reconstruction in all. Trifoliate reconstr uction of the left AV valve was selected in 93 patients (93%). Paramet ric time-related predicted survival was 92.9% at 14 years in Group 1 ( 70% confidence limits, 87.6% to 96.1%) and 75.9% at 15.4 years in Grou p 2 (70% confidence limits, 70.08% to 81.02%) (P = .038). Multivariate analysis in hazard function domain shows early repair as a negative r isk factor for death (P = .038). Ordinal logistic regression equation indicates a higher probability of preoperative AVVR with older age at operation (P = .019). Regression analysis demonstrates good correlatio n between annular size and age at repair (r = .87, P < .01) and betwee n annular size and AVVR (r = 0.68, P < .01). Parametric time-related p redicted freedom from reoperation was 82.7% at 15.4 years (70% confide nce limits, 76.9% to 88.5%). Multivariate analysis in hazard function domain demonstrated Down's syndrome as a negative risk factor for reop eration (P = .05), whereas annular dilation increased the risk of this event (P = .027). Conclusions Early correction of CAVCs is safe and b eneficial not only in controlling chronic heart failure, but also in p reventing annular dilation secondary to large QP/QS, as a potential me chanism of preoperative AVVR. Annular dilation is an incremental risk factor for reoperation. Early correction according to the double patch technique and trifoliate approach to the left AV valve reconstruction allows respect of valvar and subvalvar apparatus architecture, with a low incidence of postoperative AVVR, excellent survival rate, and low reoperative rate for residual AVVR.