LONG-TERM RESULTS AFTER REPAIR OF COMPLETE ATRIOVENTRICULAR SEPTAL-DEFECTS - ANALYSIS OF RISK-FACTORS

Background. We analyzed data from 320 patients to evaluate the impact of different preoperative, operative, and postoperative factors on We outcome after repair of complete atrioventricular septal defect. Metho ds. Between October 1974 and December 1995, 320 patients with complete atrioventricular septal defect not associated with major cardiac anom alies were operated on. Two hundred seventy-four patients underwent to tal repair. Sixty-three patients (23%) were less than 6 months old. On e hundred ninety-eight (72.2%) underwent primary repair. Seventy-six p atients (27.7%) had a previous palliative operation. Results. Operativ e mortality in patients who underwent primary repair decreased from 17 .6% (1974 to 1979) to 5.0% (1990 to 1995) despite an increase in the n umber of patients younger than 6 months. In patients undergoing a two- stage procedure operative mortality was 3.9% (late mortality, 7.9%), Y oung age (<6 months) was an incremental risk factor (p = 0.008) for op erative mortality in the early study period. Coarctation of the aorta (p = 0.02) and severe dysplastic left atrioventricular valve (p = 0.00 1) were associated with a higher risk for operative mortality. Freedom from reoperation at 10 years was 82.5% +/- 3.8%. Conclusions. In pati ents with complete atrioventricular septal defect, primary repair is t he treatment of choice and can be accomplished with good results. in o ur experience over a period of more than 20 years, earlier date of ope ration, young age (<6 months), dysplastic left atrioventricular valve, and coexisting coarctation were incremental risk factors for hospital death. The presence of a previously placed pulmonary artery band did not alter the outcome of repair. The reconstructed atrioventricular va lve shows a good and long-lasting performance. (C) 1998 by The Society of Thoracic Surgeons.