Complete Balanced Atrioventricular Septal Defect – Results of Bi-ventricular Surgical Correction

Abstract

Aim. The aim of this study was to analyze the results of surgical treatment of balanced AVSD during 10-year period in a single center. The adequacy of atrioventricular valves reconstruction was scrutinized as well as risk factors for mortality, redo surgery, pulmonary hypertension incidence were assessed. Materials and method. One hundred twenty one patients underwent surgical correction of AVSD between 2004 and 2013. All patients were operated by double patch technique with the apposition zone closure. Patients’ median age was: 109 (86–151) days, body weight: 4.5 (4–5.5) kg. Down syndrome was present in 100 (82.6%) patients. Results. Early mortality equaled 17.3% (21 patients) and late mortality was 1.7% (2 patients). Pulmonary hypertension (42.9%) and heart failure (33.3%) were the main causes. Cardiopulmonary bypass time (p < 0.0001), aortic cross-clamping time (p = 0.003), inotropic index value (p < 0.0001), maximal mean pulmonary artery pressure (p = 0.008) were significantly higher in the group of patients who died. Ten patients (8.3%) required early reoperation and nine (9%) required late reoperation. Early postoperative mitral valve regurgitation of III-rd or higher degree was risk factor for early and late reoperations (p = 0.0002). The probability of freedom from all reoperations at 6 months, 1 and 5 years was respectively: 0.83; 0.80 and 0.71. Conclusions. Pulmonary hypertension and low cardiac output syndrome have significant influence on results of AVSD treatment. The predisposing risk factors are prolonged time of surgical procedure and presence of pneumonia. Mitral valve reconstruction quality has an influence for early and late results.

Keywords

• AVSD
• mitral valve regurgitation
• redo surgery