20TY-YEAR EXPERIENCE WITH REPAIR OF COMPLETE ATRIOVENTRICULAR SEPTAL-DEFECTS

Background. To determine factors predicting mortality and morbidity af ter repair of complete atrioventricular septal defect, we retrospectiv ely analyzed preoperative, operative, and postrepair factors on the ou tcome of 115 consecutive complete atrioventricular septal defect repai rs at The Children's Hospital of Wisconsin between January 1974 and De cember 1993. Methods. For the entire experience the operative mortalit y was 13.9% (16 patients). During the most recent era, January 1988 to December 1993, operative mortality was 3.6% (2 of 55 patients). This was significantly improved from the two previous eras, January 1974 to December 1980, 28% (7 of 25) and January 1981 to December 1987, 20% ( 7 of 35 patients) (p = 0.02). There were seven late deaths; 10-year ac tuarial survival, including operative mortality was 81%. Age at comple te repair decreased; before 1982 all patients were more than 12 months of age, whereas after 1982 64% (56 of 88 patients) were 12 months of age or less. Results. Moderate or severe preoperative left atrioventri cular valve regurgitation was not a risk factor for operative mortalit y. For operative survivors with moderate to severe preoperative left a trioventricular valve regurgitation (n =17), late postoperative left a trioventricular valve regurgitation (follow-up data available on 15 pa tients) was significantly reduced (severe = 1, moderate = 5, mild = 9; p = 0.007). Conclusions. Early mortality was predicted by the era of surgical repair. Conversion to routine repair during infancy was achie ved with a simultaneous decrease in operative mortality. For patients with moderate to severe preoperative left atrioventricular valve regur gitation, significant improvement in the degree of left atrioventricul ar valve regurgitation can be expected without an increase in operativ e or late mortality or morbidity.