Complete atrioventricular septal defect repair in Australia: Results over 25 years

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.1097-685xFong, Laura S <br />Betts, Kim <br />Bell, Douglas <br />Konstantinov, Igor E <br />Nicholson, Ian A <br />Winlaw, David S <br />Orr, Yishay <br />Australian CAVSD Study Group <br />Comparative Study <br />Journal Article <br />Multicenter Study <br />Observational Study <br />Webcast <br />United States <br />J Thorac Cardiovasc Surg. 2020 Mar;159(3):1014-1025.e8. doi: 10.1016/j.jtcvs.2019.08.005. Epub 2019 Aug 30. <br />