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DOI: 10.1055/s-0029-1191524
Improved results of corrective repair for complete atrioventricular septal defect
Objective: This study evaluated the historical impact on outcome for early primary repair for complete atrioventricular septal defect (CAVSD) in our institute.
Methods: Since 1976, total of 185 children with CAVSD were referred to our unit. Before 1990, 78 children (including 67 Down syndrome) received conservative therapy without surgery, and selected 51 patients underwent corrective repair (Group 1). After 1990, almost all of referred children underwent primary repair (N=56; Group 2). Pre-, and post-operative parameters were analyzed between the groups.
Results: Age at operation was 15.4±20.4 vs. 9.9±18.0 months in Group 1 and Group 2, respectively. Association with Down syndrome (53 vs. 82%: p<0.01) and with PDA (17 vs. 65%: p<0.05) was less frequent in Group 1 compared to Group 2. No difference was seen in preoperative pulmonary vascular resistance index (RPI). Thirty-day mortality was 24.5% vs. 7.3%. Actuarial survival (73.4±6.3 vs. 90.7±4.0%; p<0.05) at 10 years was improved in Group 2. Freedom from re-operation (75.1±7.3 vs. 88.1±5.2%; p=0.11) had no significant difference. Two early deaths in Group 2 were due to pulmonary hypertension, that were operated in early infancy but their preoperative RPI were 8.7 and 10.8 U/m2.
Conclusions: In spite of earlier repair and expanded indication, recent outcome after the repair of CAVSD has improved. Extreme high RPI exceeds 8 U/m2 still remains risk for early mortality even primary repair is underwent in early infancy.