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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 387-394, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
FL Hanley, KN Fenton, RA Jonas, JE Mayer, NR Cook, G Wernovsky and AR Castaneda
Case histories of 301 patients with complete atrioventricular canal defect
presenting to our institution in infancy between January 1972 and January
1992 were reviewed with the purpose of identifying the factors responsible
for the observed improvement in perioperative mortality over this time
period. A retrospective analysis of hospital records examined 46
patient-related, morphologic, procedure-related, and postoperative
variables for associations with perioperative death and reoperation.
Operative mortality decreased significantly over the period of the study
from 25% before 1976 to 3% after 1987 (p < 0.0001). A number of the 46
variables examined showed trends over time that were similar to that for
mortality. Palliative procedures decreased over time. Reoperation for most
residual lesions also decreased to the degree that they were essentially
eliminated in recent years. The exception to this was reoperation for
postoperative left atrioventricular valve regurgitation, which also
decreased but remained at 7% in recent years. Both technical and
support-related procedural variables showed no trends over time, with the
exception of the performance of left atrioventricular valve annuloplasty,
which increased over time. Closure of the left-sided cleft was performed in
61% of the patients, with no trend over time. Annuloplasty and cleft
closure were not associated with less postoperative left atrioventricular
valve regurgitation, fewer reoperations, or lower mortality. Multivariate
logistic regression analysis identified only earlier year of operation, the
presence of double-orifice left atrioventricular valve, and postoperative
residual regurgitation of the left atrioventricular valve as risk factors
for death. Experience- related improvements in technical precision achieved
over time best account for the reduction in the rate of reoperation for
most types of residual lesions and also for the reduction in mortality. The
only residual lesion that has not been essentially completely eliminated is
left atrioventricular valve regurgitation, with reoperation for this lesion
having been reduced in recent years, but not eliminated. Improved
understanding of the structural and functional variability of the
atrioventricular valve in this lesion may be necessary before postoperative
dysfunction of this valve can be completely eliminated.
ARTICLES
Surgical repair of complete atrioventricular canal defects in infancy. Twenty-year trends
Department of Cardiovascular Surgery, Children's Hospital, Harvard Medical School, Boston, Mass.
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H. K. Najm, G. S. Van Arsdell, S. Watzka, L. Hornberger, J. G. Coles, and W. G. Williams PRIMARY REPAIR IS SUPERIOR TO INITIAL PALLIATION IN CHILDREN WITH ATRIOVENTRICULAR SEPTAL DEFECT AND TETRALOGY OF FALLOT J. Thorac. Cardiovasc. Surg., December 1, 1998; 116(6): 905 - 913. [Abstract] [Full Text] [PDF]
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S. B. O'Blenes, D. B. Ross, M. A. Nanton, and D. A. Murphy Atrioventricular septal defect with tetralogy of fallot: results of surgical correction Ann. Thorac. Surg., December 1, 1998; 66(6): 2078 - 2082. [Abstract] [Full Text] [PDF]
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V. M. Reddy, D. B. McElhinney, M. M. Brook, A. J. Parry, and F. L. Hanley Atrioventricular valve function after single patch repair of complete atrioventricular septal defect in infancy: How early should repair be attempted? J. Thorac. Cardiovasc. Surg., May 1, 1998; 115(5): 1032 - 1036. [Abstract] [Full Text] [PDF]
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J. A. M. van Son, C. K. Phoon, N. H. Silverman, and G. S. Haas Predicting Feasibility of Biventricular Repair of Right-Dominant Unbalanced Atrioventricular Canal Ann. Thorac. Surg., June 1, 1997; 63(6): 1657 - 1663. [Abstract] [Full Text]
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J. S. Tweddell, S. B. Litwin, S. Berger, D. Z. Friedberg, J. P. Thomas, P. C. Frommelt, M. A. Frommelt, A. N. Pelech, D. A. Lewis, R. T. Fedderly, et al. Twenty-Year Experience With Repair of Complete Atrioventricular Septal Defects Ann. Thorac. Surg., August 1, 1996; 62(2): 419 - 424. [Abstract] [Full Text]
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V. Alexi-Meskishvili, K. Ishino, I. Dahnert, F. Uhlemann, Y. Weng, P. E. Lange, and R. Hetzer Correction of Complete Atrioventricular Septal Defects With the Double-Patch Technique and Cleft Closure Ann. Thorac. Surg., August 1, 1996; 62(2): 519 - 524. [Abstract] [Full Text]
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C. Baufreton, D. Journois, F. Leca, W. Khoury, D. Tamisier, and P. Vouhe TEN-YEAR EXPERIENCE WITH SURGICAL TREATMENT OF PARTIAL ATRIOVENTRICULAR SEPTAL DEFECT: RISK FACTORS IN THE EARLY POSTOPERATIVE PERIOD J. Thorac. Cardiovasc. Surg., July 1, 1996; 112(1): 14 - 20. [Abstract] [Full Text]
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V. Falk, J. A. M. van Son, and F. W. Mohr Pericardial Patch Augmentation of Right Atrioventricular Valve in Atrioventricular Canal Ann. Thorac. Surg., July 1, 1996; 62(1): 288 - 290. [Abstract] [Full Text]
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H. Velvis, M. H. Hines, H. S. Klopfenstein, D. D. Berry, and J. Vinten-Johansen DEPRESSION OF CARDIAC FUNCTION AFTER DEEP HYPOTHERMIC CIRCULATORY ARREST IN DEEPLY ANESTHETIZED NEONATAL LAMBS J. Thorac. Cardiovasc. Surg., February 1, 1996; 111(2): 359 - 366. [Abstract] [Full Text]
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G. Michielon, G. Stellin, G. Rizzoli, O. Milanesi, M. Rubino, G. Svaluto Moreolo, and D. Casarotto Left atrioventricular valve incompetence after repair of common atrioventricular canal defects Ann. Thorac. Surg., December 1, 1995; 60(suppl_3): S604 - S609. [Abstract] [PDF]
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E. K. W. Sim, M. D. Black, J. Smallhorn, and W. G. Williams Surgical repair of complete atrioventricular septal canal defects with absent posterior leaflet Ann. Thorac. Surg., November 1, 1995; 60(5): 1399 - 1400. [Abstract] [PDF]
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K. Bando, M. W. Turrentine, K. Sun, T. G. Sharp, G. J. Ensing, A. P. Miller, K. A.Kesler, R. S. Binford, G. N. Carlos, R. A. Hurwitz, et al. SURGICAL MANAGEMENT OF COMPLETE ATRIOVENTRICULAR SEPTAL DEFECTSA twenty-year experience J. Thorac. Cardiovasc. Surg., November 1, 1995; 110(5): 1543 - 1554. [Abstract] [Full Text]
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C. L. Backer, C. Mavroudis, E. T. Alboliras, and V. R. Zales Repair of complete atrioventricular canal defects: Results with the two-patch technique Ann. Thorac. Surg., September 1, 1995; 60(3): 530 - 537. [Abstract] [PDF]
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B. Marino Complete atrioventricular septal defect in patients with and without Dawn's syndrome Ann. Thorac. Surg., June 1, 1994; 57(6): 1687 - 1687. [PDF]
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