Repair of Partial Atrioventricular Septal Defects in Adults: A Single Center Experience
Nishant Saran, Joseph Dearani, Alexander Egbe, Heidi Connolly, Carole Warnes, Hartzell Schaff, *Sameh Said
Mayo clinic, Rochester, MN
Background: Limited data are available on long-term outcome after repair of partial atrioventricular septal defects (pAVSD) in adults. We sought to review our experience.
Methods: Between January 1993 and December 2016, 52 patients (≥18 years of age) underwent primary pAVSD repair. The most common associated defects were: secundum atrial septal defect (ASD) (n=12) and ventricular septal defect (VSD) (n=5). Left atrioventricular valve (LAVV) zone of apposition (ZOA) was complete in 16 patients. There was 1 patient with double-orifice LAVV and 4 patients with abnormal papillary muscles. Autologous (n=35, 65%) and bovine (n=15, 31%) pericardial patches were used for primum ASD closure. LAVV repair techniques included: ZOA suture closure (n= 43), ring (n=8) and suture (n=4) annuloplasty. None had LAVV replacement. The most common concomitant procedures were: right atrioventricular valve (RAVV) repair (n=14), VSD closure (n=5), arrhythmia surgery (n=8) and myectomy (n=1).
Results: Median age was 39.2 years (range 19.2-69.9) with 35 (66%) females. Down syndrome was present in 25% (n=13). LAVV regurgitation ( ≥moderate) was present in 61% (n=31) patients. Associated pathologies included: ≥moderate RAVV regurgitation (n=19), left ventricular outflow-tract obstruction (LVOTO) (n=3), atrial arrhythmia (n=9), conduction abnormalities (n=3). Median cross-clamp and perfusion times were 44 minutes (Inter Quartile Range 32-64) and 57 minutes (Inter Quartile Range 44-93), respectively. There was no operative mortality. Permanent pacemaker was implanted in 2 patients for pre-existing heart block. Median follow up was 8.9years (maximum 24.1). Follow-up echocardiogram (range 1-15years) showed reduction in median right ventricle systolic pressure (RVSP) from 54 (range 43-127) to 29mmHg (range 16-71) in patients (n=13) who had RVSP>40 at primary repair. In the subgroup of 20 patients who were re-assessed at least 5 years following surgery (range 5.2–24.1), one patient (5%) was found to have recurrent severe LAVV regurgitation. Freedom from reoperation at 5, 10 and 15 years was 97%, 92% and 51% respectively. The most common indications for reoperations (n=5) were: LVOTO (n=3), followed by recurrent LAVV regurgitation (n=3) and LAVV stenosis (n=2). There was 100% survival.
Conclusion: Repair of pAVSD in adults has excellent outcomes with low reoperation rate. The most common indications for repeat surgery are recurrent LAVV pathology and LVOTO emphasizing the need for informed follow-up.
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