Is the modified single-patch repair superior to the double-patch repair of complete atrioventricular septal defects?

Abstract

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, 'Is the modified single-patch repair superior to the double-patch repair of complete atrioventricular septal defects?'. A total of 634 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question, which included 1 meta-Analysis and 8 cohort studies. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. There was limited high-quality evidence available, with all the included studies being retrospective and observational in nature. One meta-Analysis and 8 cohort studies provided evidence that there was no significant difference in survival or other postoperative outcomes based on a surgical technique during follow-up ranging from 6 months to 4.2 years. Surgical reintervention for development of left ventricular outflow tract obstruction, left atrioventricular valve dysfunction or residual septal defects after the initial repair of complete atrioventricular septal defect was not significantly different between cohorts in almost all studies. Cardiopulmonary bypass and aortic cross-clamp times were significantly shorter with the modified single-patch repair compared to the double-patch repair in all studies that examined these variables, but this did not correspond to a difference in outcomes. We conclude, based on the available evidence, that the modified single-patch repair of complete atrioventricular septal defect is similar to the double-patch repair in terms of postoperative outcomes. However, this conclusion is limited by the retrospective nature of all studies, small cohort sizes and short durations of follow-up in addition to lack of statistical analysis in 1 study.