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The effect of surgical technique, age, and Trisomy 21 on early outcome of surgical management of complete atrioventricular canal defect

Part of: Cardiac Morphology

Published online by Cambridge University Press:  05 August 2021

Sherief Azzab ,
Ahmed Samy ,
Hamdy Singab ,
Mohamed Zeinah ,
Gledisa Musollari ,
Ariana Axiaq ,
Amer Harky Open the ORCID record for Amer Harky [Opens in a new window] ,
Ahmed Tarek  and
Mohamed El Ghanam
Sherief Azzab
Affiliation:
Department of Cardiothoracic Surgery, Ain Shams University Hospitals, Cairo, Egypt
Ahmed Samy
Affiliation:
Department of Cardiothoracic Surgery, Ain Shams University Hospitals, Cairo, Egypt
Hamdy Singab
Affiliation:
Department of Cardiothoracic Surgery, Ain Shams University Hospitals, Cairo, Egypt
Mohamed Zeinah
Affiliation:
Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
Gledisa Musollari
Affiliation:
School of Medicine, Imperial College, London, UK
Ariana Axiaq
Affiliation:
School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
Amer Harky
Affiliation:
Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
Ahmed Tarek
Affiliation:
Department of Cardiothoracic Surgery, Ain Shams University Hospitals, Cairo, Egypt
Mohamed El Ghanam*
Affiliation:
Department of Cardiothoracic Surgery, Ain Shams University Hospitals, Cairo, Egypt
*
Author for correspondence: Dr Mohamed El Ghanam, Department of Cardiothoracic Surgery, Ain Shams University Hospitals, Cairo, Egypt. Tel: +20-122-733-7256. E-mail: mohamedelghanam@yahoo.com
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Abstract

Background:

The optimal timing, surgical technique, and the influence of Trisomy 21 on the outcome of surgical repair of Complete Atrioventricular Canal Defect remains uncertain. We reviewed our experience in the repair of CAVC to identify the influence of these factors on operative outcomes.

Methods:

A prospective study included 70 patients, who underwent repair of CAVC at our institute between July, 2016 and October, 2019. Primary endpoint was mortality and the secondary endpoint was a degree of left atrioventricular valve regurgitation.

Results:

No significant difference was noted between patients operated on, at the first 6 months of age versus later, regarding mortality or LAVV regurgitation. Surgical repair by modified single-patch technique showed a significant reduction in bypass time (71.13 ± 13.507 min versus 99.19 ± 27.092 min, p-value = 0.001). Compared to closure of cleft only, posterior annuloplasty used for repair of LAVV resulted in significant reduction in the occurrence of post-operative valve regurgitation during the early period (LAVV 2 + 43 versus 7 %, p-value = 0.03) and at 6 months of follow-up (LAVV 2 + 35.4 versus 0 %, p-value = 0.01), respectively.

Conclusions:

Early intervention, in the first 6 months in patients with CAVC by surgical repair gives comparable acceptable results to later repair; Trisomy 21 was not found to be a risk factor for early intervention. Repair of common AV valve by cleft closure with posterior LAVV annuloplasty showed better results with a significant decrease in post-operative LAVV regurgitation and early mortality in comparison to the closure of cleft only.

Keywords

Complete atrioventricular canalDown syndromedouble-patch techniquemodified single patchposterior annuloplasty
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 6 , June 2022 , pp. 869 - 873
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Rastelli, G, Kirklin, JW, Titus, JL. Anatomic observations on complete form of persistent common atrioventricular canal with special reference to atrioventricular valves – PubMed. Mayo Clin Proc 1996; 41: 296–308. https://pubmed.ncbi.nlm.nih.gov/5932615/.Google Scholar
Calabrò, R, Limongelli, G. Complete atrioventricular canal. Orphanet J Rare Dis BioMed Central; 2006: 8. doi: 10.1186/1750-1172-1-8.CrossRefGoogle Scholar
Berger, TJ, Kirklin, JW, Blackstone, EH, Pacifico, AD, Kouchoukos, NT. Primary repair of complete atrioventricular canal in patients less than 2 years old. Am J Cardiol 1978; 41: 906–913. doi: 10.1016/0002-9149(78)90732-4.CrossRefGoogle ScholarPubMed
Hanley, FL, Fenton, KN, Jonas, RA, et al. Surgical repair of complete atrioventricular canal defects in infancy: Twenty-year trends. J Thorac Cardiovasc Surg 1993; 106: 387–397. doi: 10.1016/s0022-5223(19)34070-x.CrossRefGoogle ScholarPubMed
Crawford, FA, Stroud, MR. Surgical repair of complete atrioventricular septal defect. Ann Thorac Surg Elsevier; 2001; 72: 1621–1629. doi: 10.1016/S0003-4975(01)03170-8.CrossRefGoogle ScholarPubMed
Vida, VL, Tessari, C, Castaldi, B, et al. Early correction of common atrioventricular septal defects: a single-center 20-year experience. Ann Thorac Surg Elsevier USA; 2016; 102: 2044–2051. doi: 10.1016/j.athoracsur.2016.09.020.CrossRefGoogle ScholarPubMed
St. Louis, JD, Jodhka, U, Jacobs, JP, et al. Contemporary outcomes of complete atrioventricular septal defect repair: analysis of the society of thoracic surgeons congenital heart surgery database. J Thorac Cardiovasc Surg Mosby Inc.; 2014; 148: 2526–2531. doi: 10.1016/j.jtcvs.2014.05.095.CrossRefGoogle Scholar
Ginde, S, Lam, J, Hill, GD, et al. Long-term outcomes after surgical repair of complete atrioventricular septal defect. J Thorac Cardiovasc Surg Mosby Inc.; 2015; 150: 369–374. doi: 10.1016/j.jtcvs.2015.05.011.CrossRefGoogle ScholarPubMed
Michielon, G, Stellin, G, Rizzoli, G, Casarotto, DC. Repair of complete common atrioventricular canal defects in patients younger than four months of age. Circulation 1997; 96 (9 SUPPL.): II–316. http://intl-circ.ahajournals.org/cgi/content/full/96/9/II.Google ScholarPubMed
Stellin, G. Surgical treatment of complete A-V canal defects in children before 3 months of age. Eur J Cardio-Thorac Surg. Oxford Academic; 2003; 23: 187–193. doi: 10.1016/S1010-7940(02)00760-1.CrossRefGoogle Scholar
Nicholson, IA, Nunn, GR, Sholler, GF, et al. Simplified single patch technique for the repair of atrioventricular septal defect. J Thorac Cardiovasc Surg Mosby Inc.; 1999; 118: 642–647. doi: 10.1016/S0022-5223(99)70009-7.CrossRefGoogle ScholarPubMed
Wilcox, BR, Jones, DR, Frantz, EG, et al. Anatomically sound, simplified approach to repair of “complete” atrioventricular septal defect. Ann Thorac Surg Elsevier; 1997; 64: 487–494. doi: 10.1016/S0003-4975(97)00566-3.CrossRefGoogle ScholarPubMed
Jonas, RA, Mora, B. Individualized approach to repair of complete atrioventricular canal: selective use of the traditional single-patch technique versus the australian technique. World J Pediatr Congenit Heart Surg 2010; 1: 78–86. doi: 10.1177/2150135110361510.CrossRefGoogle ScholarPubMed
Mavroudis, C, Backer, CL. The two-patch technique for complete atrioventricular canal. Semin Thorac Cardiovasc Surg 1997; 9: 35–43. https://europepmc.org/article/med/9109223.Google ScholarPubMed
Maloney, JV., Marable, SA, Mudler, DG. The surgical treatment of common atrioventricular canal. J Thorac Cardiovasc Surg. Mosby; 1962; 43: 84–96. doi: 10.1016/s0022-5223(20)31630-5.CrossRefGoogle ScholarPubMed
Jeong, IS, Lee, CH, Lee, C, et al. Institutional report – congenital surgical outcomes of the modified single-patch technique in complete atrioventricular septal defect. Interact Cardiovasc Thorac Surg 2009: 435–437. doi: 10.1510/icvts.2008.192872.CrossRefGoogle Scholar
Nunn, GR. Atrioventricular canal: modified single patch technique. Pediatr Cardiac Surg Ann. W.B. Saunders; 2007; 10: 28–31. doi: 10.1053/j.pcsu.2007.01.009.Google Scholar
Yasui, H, Nakamura, Y, Kado, H, et al. Primary repair for complete atrioventricular canal: recommendation for early primary repair. J Cardiovasc Surg 1990: 498–504. https://europepmc.org/article/med/2211806.Google Scholar
Mavroudis, C, Weinstein, G, Turley, K, Ebert, PA. Surgical management of complete atrioventricular canal. J Thorac Cardiovasc Surg Mosby; 1982; 83: 670–679. doi: 10.1016/s0022-5223(19)37205-8.CrossRefGoogle ScholarPubMed
Günther, T, Mazzitelli, D, Haehnel, CJ, Holper, K, Sebening, F, Meisner, H. Long-term results after repair of complete atrioventricular septal defects: analysis of risk factors. Ann Thorac Surg Elsevier; 1998; 65: 754–760. doi: 10.1016/S0003-4975(98)00028-9.CrossRefGoogle ScholarPubMed
Suzuki, T, Bove, EL, Devaney, EJ, et al. Results of definitive repair of complete atrioventricular septal defect in neonates and infants. Ann Thorac Surg Elsevier; 2008; 86: 596–602. doi: 10.1016/j.athoracsur.2008.02.032.CrossRefGoogle ScholarPubMed
Atz, AM, Hawkins, JA, Lu, M, et al. Surgical management of complete atrioventricular septal defect: Associations with surgical technique, age, and trisomy 21. J Thorac Cardiovasc Surg NIH Public Access; 2011; 141: 1371–1379. doi: 10.1016/j.jtcvs.2010.08.093.CrossRefGoogle ScholarPubMed
Reddy, VM, McElhinney, DB, Brook, MM, et al. Atrioventricular valve function after single patch repair of complete atrioventricular septal defect in infancy: How early should repair be attempted? J Thorac Cardiovasc Surg Mosby Inc.; 1998; 115: 1032–1040. doi: 10.1016/S0022-5223(98)70402-7.CrossRefGoogle ScholarPubMed
Singh, RR, Warren, PS, Reece, TB, Ellman, P, Peeler, BB, Kron, IL. Early repair of complete atrioventricular septal defect is safe and effective. Ann Thorac Surg 2006; 82: 1598–1602. doi: 10.1016/j.athoracsur.2006.05.102.CrossRefGoogle ScholarPubMed
Parikh, KN, Shah, NC, Myers, JL, Kunselman, AR, Clark, JB. Complete atrioventricular canal defect: influence of timing of repair on intermediate outcomes. World J Pediatr Congenit Heart Surg SAGE Publications; 2017; 8: 361–366. doi: 10.1177/2150135117696492.CrossRefGoogle Scholar
Fong, LS, Winlaw, DS, Orr, Y. Is the modified single-patch repair superior to the double-patch repair of complete atrioventricular septal defects? Interact cardiovasc Thorac Surg Oxford University Press; 2019; 28: 427–431. doi: 10.1093/icvts/ivy261.CrossRefGoogle Scholar
Myers, PO, del Nido, P, Marx, G, et al. Annuloplasty at atrioventricular canal repair improves late left atrioventricular valve function. J Am Coll Cardiol Elsevier BV; 2012; 59: E776. doi: 10.1016/s0735-1097(12)60777-3.CrossRefGoogle Scholar
Al-Hay, AA, MacNeill, SJ, Yacoub, M, Shore, DF, Shinebourne, EA. Complete atrioventricular septal defect, Down syndrome, and surgical outcome: risk factors. Ann Thorac Surg 2003; 75: 412–421. doi: 10.1016/s0003-4975(02)04026-2.CrossRefGoogle ScholarPubMed
Mahadevaiah, G, Gupta, M, Ashwath, R. Down syndrome with complete atrioventricular septal defect, hypertrophic cardiomyopathy, and pulmonary vein stenosis. Tex Heart Inst J 2015; 42: 458–461. Published 2015 Oct 1. doi: 10.14503/THIJ-14-4256.CrossRefGoogle ScholarPubMed
Formigari, R, di Donato, RM, Gargiulo, G, et al. Better surgical prognosis for patients with complete atrioventricular septal defect and Down’s syndrome. Ann Thorac Surg 2004; 78: 666–672. doi: 10.1016/j.athoracsur.2003.12.021.CrossRefGoogle ScholarPubMed
Kaza, AK, Colan, SD, Jaggers, J, et al. Surgical interventions for atrioventricular septal defect subtypes: the pediatric heart network experience. Ann Thorac Surg 2011; 92: 1468–1475. doi: 10.1016/j.athoracsur.2011.04.109.CrossRefGoogle ScholarPubMed