Congenital: Atrioventricular Septal Defect
Complete atrioventricular septal defect repair in Australia: Results over 25 years

Read at the 99th Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, May 4-7, 2019.
https://doi.org/10.1016/j.jtcvs.2019.08.005Get rights and content
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Abstract

Objectives

To evaluate whether the long-term outcomes of modified-single-patch (MSP) repair of complete atrioventricular septal defect are equivalent to double-patch (DP) repair with respect to survival and risk of reoperation for left atrioventricular valve regurgitation or left ventricular outflow tract obstruction.

Methods

All patients who underwent biventricular repair of complete atrioventricular septal defect in Australia from 1990 to 2015 using either a MSP or DP technique were identified. Demographic characteristic details, operative data, and outcomes were analyzed. A propensity score analysis was performed to balance the 2 treatment groups according to several baseline covariates. Survival and freedom from reintervention between the 2 groups were compared using Kaplan-Meier curves and log-rank tests.

Results

A total of 819 patients underwent repair of complete atrioventricular septal defect (252 MSP and 567 DP) during the study period. There was no significant difference in unmatched survival (P = .85) and event-free survival (P = .49) between MSP and DP repair. Propensity score matching resulted in a total of 223 matched pairs. Matched analysis found no difference in overall survival (P = .59) or event-free survival (P = .90) between repair techniques, with an estimated event-free survival at 5, 10, and 15 years of 83%, 83%, and 74% for DP and 83%, 80%, and 77% for the MSP group, respectively. There was no significant difference between repair techniques in reoperation for left atrioventricular valve regurgitation or left ventricular outflow tract obstruction or need for permanent pacemaker.

Conclusions

Overall and event free survival are similar following either MSP or DP repair of complete atrioventricular septal defect. There is no increased risk of reoperation for left ventricular outflow tract obstruction with the MSP technique.

Graphical abstract

In a propensity-matched multi-institutional study overall and event-free survival are similar following either MSP or double patch repair of CAVSD. There is no increased risk of reoperation for LVOTO with the MSP technique.

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Key Words

complete atrioventricular septal defect
complete AV canal
atrioventricular septal defect
AVSD

Abbreviations and Acronyms

ASD
atrial septal defect
CAVSD
complete atrioventricular septal defect
DP
double patch
LAVV
left atrioventricular valve
LAVVR
left atrioventricular valve regurgitation
LVOTO
Left ventricular outflow tract obstruction
MSP
modified single patch
PPM
permanent pacemaker
VSD
ventricular septal defect
ZOA
zone of apposition

Cited by (0)

Supported by the National Heart Foundation of Australia via health professional scholarship No. 101616 (to Dr Fong).

A complete list of Australian CAVSD study group collaborators appears in the Acknowledgments.