PRIMUM ATRIAL SEPTAL-DEFECT IN CHILDREN - EARLY RESULTS, RISK-FACTORS, AND FREEDOM FROM REOPERATION

Background. Repair of primum atrial septal defect in children usually is associated with a low operative mortality, except for a subgroup of children with congestive heart failure. To determine the early mortal ity and incidence of reoperation in children with primum atrial septal defect, we analyzed retrospectively the results of patients who under went repair of this defect. Methods. Between July 1982 and December 19 96, 180 children underwent repair of primum atrial septal defect. The mean age at repair was 4.6 years (median, 3.6 years; range, 1 month to 16.4 years); of the 180 children, 23 were infants less than 1 year of age. Absent or mild symptoms were present in 145 (80%), whereas 34 (2 0%) of children presented with severe symptoms or congestive heart fai lure. Results. Early mortality occurred in 3 (1.6%); 2 were less than 1 year of age. Follow-up ranged from 2 months to 14.5 years (mean, 6 /- 4.2 years). Actuarial survival is 98% at 10 years with no late deat hs. Age less than 1 year is a predictor of death. During follow-up, 17 (9%) of the 180 patients underwent reoperation, 5 of whom were in the infant group. Five underwent reoperation for subaortic obstruction, a nd 12 for left atrioventricular valve regurgitation of whom 11 were re paired; and 1 required valve replacement. Age and preoperative moderat e-to-severe left atrioventricular valve regurgitation were predictors of reoperation. Conclusions. Results of the repair of primum atrial se ptal defect during childhood are favorable. Infants have a higher risk for death and reoperation. Left atrioventricular valve insufficiency and subaortic stenosis are important late complications and can be rep aired safely at reoperation. (Ann Thorac Surg 1998;66:829-35) (C) 1998 by The Society of Thoracic Surgeons.