Results of primary two-patch repair of complete atrioventricular septal defect

Objective: The policy of primary repair of complete atrioventricular septal defect (CAVSD), using a two-patch technique, was evaluated with special at tention to the risk of implantation of a prosthetic atrioventricular (AV) v alve. Methods: From 1986 to 1999, all 97 patients who underwent primary rep air for CAVSD were included in a retrospective analysis. Seventy-five patie nts (75%) had Down's syndrome. Preoperative echocardiographic AV valve regu rgitation was absent or limited in 85 (88%), moderate in seven (7%) and sev ere in five (5%). Fifty-six patients (58%) were on diuretics, six (6%) on a rtificial ventilation and four (4%) were on inotropic support. The mean age at operation was 10.2 months (SD, 16.4). with a mean weight of 5.9 kg (SD, 3.7). Results: Early mortality comprised three patients (4%), and late mor tality two patients. Follow up was complete and comprised 402 patient-years (mean, 4.5 years; SD, 3.2). The cumulative survival at 10 years was 93% (9 5% CI, 89-97%). Multivariate analysis with regard to mortality revealed no associations with any of the analyzed factors. Fight patients were reoperat ed, all for regurgitant left AV valve. The reoperation-free survival at 10 years was 83% (95% CI, 75-91%). Multivariate analysis with regard to reoper ation showed bring on preoperative diuretics to be a decreasing risk factor (Odd's Ratio (OR), 0.13; 95% CI, 0.00-0.99; P = 0.005) and significant pos toperative left AV valve regurgitation to be an increasing risk factor (OR, 9.90; 95% CI. 1.90-53.0; P = 0.001). Only one prosthetic valve was implant ed (annual linearized risk of 0.002/patient-year). At the latest follow up of the surviving patients, left AV valve regurgitation was absent or limite d in 83 (90%) and moderate in nine (10%). Right AV valve regurgitation was absent or limited in all 92 (100%) patients. All surviving patients are thr iving well, seven (8%) of whom are on diuretics. Conclusions: Primary repai r of CAVSD with a two-patch technique, including cleft closure of the left AV valve, has good clinical and functional results without problems for the right-sided AV valve. The need for prosthetic valve implantation for the l eft AV valve is minimal. (C) 2000 Elsevier Science B.V. All rights reserved .