Congenital: Atrioventricular Septal Defect
Early repair of complete atrioventricular septal defect has better survival than staged repair after pulmonary artery banding: A propensity score–matched study

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Abstract

Objectives

Complete atrioventricular septal defect (cAVSD) repair is usually performed between 3 and 6 months of age. However, some children present with early heart failure requiring intervention. It is unclear whether primary complete repair or initial pulmonary artery banding (PAB) provides better outcomes.

Methods

All patients (n = 194) who underwent surgery for cAVSD younger than 3 months of age between 1990 and 2019 were included. Propensity score matching was performed on risk factors for mortality.

Results

Primary complete repair was performed in 77.8% (151/194), whereas PAB was performed in 22.2% (43/194). Children who had PAB were younger (P < .01), had lower weight (P < .001), and less trisomy 21 (P = .04). Interstage mortality for PAB was 18.6% (8/43), whereas early mortality for primary repair was 3.3% (5/151). Survival at 20 years was 92.0% (95% confidence interval [CI], 85.6%-95.7%) for primary repair and 63.2% (95% CI, 42.5%-78.1%) for PAB (P < .001). There was no difference in left atrioventricular valve (LAVV) reoperation rates (P = .94). Propensity score matching produced 2 well-matched groups. Survival at 20 years was 94.2% (95% CI, 85.1%-98.8%) for primary repair, and 58.4% (95% CI, 33.5%-76.7%) for PAB (P = .001). There was no difference in LAVV reoperation rates (P = .71). Neonatal repair was achieved with no early deaths and 100% survival at 10 years.

Conclusions

In children younger than 3 months of age, complete repair of cAVSD is associated with better survival than PAB. Both strategies have similar rates of LAVV reoperation. Neonatal repair of cAVSD can be achieved with excellent results. Primary repair of cAVSD should be the preferred strategy in children younger than 3 months of age.

Graphical abstract

In a propensity-matched analysis, primary complete repair is associated with better survival than initial PA banding in patients with cAVSD requiring surgery at younger than 3 months of age.

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Key Words

atrioventricular septal defect
atrioventricular valve
pulmonary artery banding
neonates
propensity matching

Abbreviations and Acronyms

cAVSD
complete atrioventricular septal defect
CI
confidence interval
LAVV
left atrioventricular valve
LAVVR
left atrioventricular valve regurgitation
PAB
pulmonary artery banding

Cited by (0)

Dr Buratto is a recipient of a Postgraduate Scholarship from the National Health and Medical Research Council and an Australian Government Research Training Program Scholarship (1134340). Dr d'Udekem is a National Health and Medical Research Council Clinician Practitioner Fellow (1082186).