10-YEAR EXPERIENCE WITH SURGICAL-TREATMENT OF PARTIAL ATRIOVENTRICULAR SEPTAL-DEFECT - RISK-FACTORS IN THE EARLY POSTOPERATIVE PERIOD

Partial atrioventricular septal defects are electively repaired with g ood results, However, recent reports suggest that such repair is poten tially a high-risk surgical procedure, Our aim was to determine the ri sk factors of adverse outcome early after surgical treatment of atriov entricular septal defects in our hospital. A retrospective study was d one in 100 consecutive patients from 2 months to 50.6 years old (media n 3.6 years) who underwent surgical correction between January 1984 an d December 1993, An intermediate form of the lesion was noted in 31% o f cases, Congestive heart failure occurred in 50% of cases, Preoperati ve left atrioventricular valve incompetence (moderate to severe) was p resent in 63% of patients, Severe abnormalities of left subvalvular ap paratus were noted in 28% of patients, The cleft of the left atriovent ricular valve was closed in 76% of cases, The study was done to determ ine risk factors associated with hospital mortality (13%), postoperati ve residual left atrioventricular valve incompetence (23%), and early reoperation (14%) within the first 30 postoperative days, Univariate a nalysis shared that age at the date of operation and cleft closure wer e not related to an early adverse outcome, A stepwise logistic regress ion with variables selected by univariate analysis identified infectio ns and se,ere abnormalities of left subvalvular apparatus as predictiv e factors of early death (odds ratios, 28.07 and 6.18, respectively), preoperative left atrioventricular value regurgitation as a predictive factor of residual postoperative left atrioventricular valve regurgit ation (odds ratio, 5.34), and severe abnormalities of left subvalvular apparatus as a predictive factor of early reoperation (odds ratio, 5. 27), These results emphasize the importance of the severity of the mor phologic features of the left subvalvular apparatus, the occurrence of early postoperative infections, and the presence of residual left atr ioventricular valve regurgitation as risk factors in the early period after surgical correction of partial atrioventricular septal defects.