A novel repair for patients with atrioventricular septal defect requiring reoperation for left atrioventricular valve regurgitation

Objective: Left atrioventricular valve regurgitation (LAVVR) is the most fr equent indication for reoperation following atrioventricular septal defect (AVSD) repair. We estimate from our experience that within 10 years of init ial repair, 14% of patients undergoing repair of atrioventricular septal de fect (AVSD) require reoperation for this complication. We have developed a novel leaflet augmentation technique For LAVVR which may avoid failure of c onventional repair and/or the need for valve replacement. Method: The novel technique consists of insertion of a glutaraldehyde-treated autologous per icardial patch to augment the bridging leaflets of the atrioventricular val ve, We describe the outcome of eight patients in whom this technique was us ed and compared them to 68 other patients with AVSD undergoing reoperation for LAVVR by either conventional repair (n = 54) or valve replacement (n = 14). Results: There were no early deaths or major complications following p atch repair. The mean follow-up is 2.3 years (range 1-8.5 years) during whi ch there were no late deaths. Two patients underwent reintervention at 3.5 and 5 years after patch repair for LAVVR and were successfully rerepaired. Mild residual LAVVR was seen at last echocardiography in six patients and m ild to moderate in two. These results compare favorably with the 68 patient s who underwent conventional surgery. The 3-year freedom from reoperation w as 86% for both repair groups. Dysplastic valve tissue appears to be a majo r risk factor for failure of conventional repair or for valve replacement. Failure of conventional valve repair led to valve replacement in six of sev en patients. Conclusions: For patients with late LAVVR after AVSD repair, p ericardial leaflet augmentation is durable and may avoid failure of convent ional repair or valve replacement in patients with dysplastic valves. (C) 2 000 Elsevier Science B.V. All rights reserved.