The simplified single patch repair of complete atrioventricular septal defect

Abstract

Between May 1995 and November 2003, 88 consecutive patients referred to 2 consultant cardiac surgeons (GN and IN) for repair of complete AVSD had this technique used. The mean age at operation was 8.3 months (median 3.3 months, range 1 to 40 months). The mean weight at operation was 5.7 kg (range 2.3 to 16.8). Down syndrome was present in 63 patients (71.6%). The size of the ventricular septal defect was graded on preoperative echocardiography by cardiology review as restrictive (14 patients), moderate (21 patients), or large (47 patients). All patients had the described technique performed with no modi- fications, regardless of the size of the ventricular component. Nine patients had associated tetralogy of Fallot or pulmonary atresia anatomy. These patients were all initially treated with modified Blalock Taussig GoreTex shunts. Later repair of tetralogy (2 patients) or construction of RV-PA conduit (7 patients) at the time of AVSD repair was performed. Four patients had pulmonary artery banding due to small size and later had debanding and complete AVSD repair. There were 3 early deaths (3.4%). All 3 had other associated surgery at the time of AVSD repair (1 tetralogy repair, 1 RV-PA conduit for pulmonary atresia, and one aortic and pulmonary valvotomy for aortic stenosis and pulmonary stenosis). Of the survivors, post procedure echocardiography revealed mild or less mitral regurgitation in 73 patients (86%), moderate regurgitation in 7 (8%), and severe in 1 patient. Follow-up was performed on 78 of the 85 survivors at a median of 30 months (mean 36 months, range 0 to 97 months). Two patients required mitral valve replacement (2.5%). One of these patients had severe and one moderate mitral regurgitation recorded at initial post AVSD repair echocardiography. Of the remaining patients, 73 had mild or less mitral regurgitation (93.5%) and 3 had moderate regurgitation (4%). In general, this technique has lead to reduced cross clamp times and overall bypass time in our hands. It effectively eliminates an extra suture line used in other techniques. We have had good mitral valve function postoperatively and have not seen significant left ventricular outflow tract obstruction despite our initial theoretical concerns. We have applied this simplified technique to all of our AVSD patients regardless of size of ventricular defect. © 2004 Elsevier Inc. Al rights reserved.