Surgical treatment for complete atrioventricular septal defect in patients above the optimal age_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Guanxi , MA Kai , QI Lei , PANG Kunjing , LIN Ye , ZHANG Benqing , RUI Lu , LIU Rui , ZHANG Sen , YANG Yang , FENG Zicong , MAO Fengqun , YUAN Jianhui ,  LI Shoujun

Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P.R.China;

Corresponding author：

LI Shoujun, Email: drlishoujunfw@163.com

Keywords：

Complete atrioventricular septal defect; atrioventricular valve regurgitation; reoperation rate; surgery

DOI：

10.7507/1007-4848.202005011

Video：

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Objective To summarize the clinical outcomes and experience of surgical treatment for patients with complete atrioventricular septal defect (CAVSD) above the optimal age for surgery.Methods We retrospectively reviewed clinical data of 163 simple type CAVSD patients less than 7 years who underwent operations in Fuwai Hospital from 2002 to 2013. The patients were divided into a normal group (n=84, including 37 males and 16 females with an average age of 7.6±2.7 months) and an over-age group (n=79, including 30 males and 49 females with an average age of 34.6±19.6 months) according to whether the age was more than 1 year.Results The average aortic cross clamp time (88.3±24.4 min vs. 106.1±35.4 min, P<0.001) and cardiopulmonary bypass time (123.6±31.1 min vs. 142.6±47.1 min, P=0.003) were statistically different between the two groups. During the follow-up period (the normal group 53.3±43.9 months, the over-age group 57.2±48.2 months), there was no statistical difference in all-cause mortality (10.7% vs. 8.9%, P=0.691), the incidence of moderate or severe left atrioventricular valve regurgitation (16.7% vs. 21.5%, P=0.430) and reintervention rate (3.6% vs. 0.0%, P=0.266) between the two groups. No left ventricular outflow tract obstruction and complete atrioventricular block occurred in both groups.Conclusion For CAVSD children above the optimal age, rational surgical treatments can also achieve satisfying results.

Citation： WANG Guanxi, MA Kai, QI Lei, PANG Kunjing, LIN Ye, ZHANG Benqing, RUI Lu, LIU Rui, ZHANG Sen, YANG Yang, FENG Zicong, MAO Fengqun, YUAN Jianhui, LI Shoujun. Surgical treatment for complete atrioventricular septal defect in patients above the optimal age. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(6): 691-695. doi: 10.7507/1007-4848.202005011 Copy

1.	Jonas RA, 主编. 刘锦纷, 译. 先天性心脏病外科综合治疗学. 第2版. 上海: 世界图书出版公司, 2016. 513-530.
2.	Fukushima H, Kosaki K, Sato R, et al. Mechanisms underlying early development of pulmonary vascular obstructive disease in down syndrome: An imbalance in biosynthesis of thromboxane A2 and prostacyclin. Am J Med Genet A, 2010, 152A(8): 1919-1924.
3.	Craig B. Atrioventricular septal defect: From fetus to adult. Heart, 2006, 92(12): 1879-1885.
4.	Xie O, Brizard CP, d'Udekem Y, et al. Outcomes of repair of complete atrioventricular septal defect in the current era. Eur J Cardiothorac Surg, 2014, 45(4): 610-617.
5.	Kogon BE, Butler H, McConnell M, et al. What is the optimal time to repair atrioventricular septal defect and common atrioventricular valvar orifice? Cardiol Young, 2007, 17(4): 356-359.
6.	陈寄梅, 李守军代表国家心血管病专家委员会先天性心脏病专业委员会. 先天性心脏病外科治疗中国专家共识 (六): 完全型房室间隔缺损. 中国胸心血管外科临床杂志, 2020, 27(7): 725-731.
7.	李守军, 高峰, 吴清玉, 等. 完全性房室通道的外科治疗. 中国胸心血管外科临床杂志, 2005, 12(5): 323-325.
8.	Wang G, Ma K, Pang K, et al. Modified single repair technique for complete atrioventricular septal defect: A propensity score matching analysis. Pediatr Cardiol, 2020, 41(3): 615-623.
9.	Fong LS, Betts K, Bell D, et al. Complete atrioventricular septal defect repair in Australia: Results over 25 years. J Thorac Cardiovasc Surg, 2020, 159(3): 1014-1025 e1018.
10.	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, 2019, 28(3): 427-431.
11.	Bell D, Thakeria P, Betts K, et al. Propensity-matched comparison of the long-term outcome of the nunn and two-patch techniques for the repair of complete atrioventricular septal defects. Eur J Cardiothorac Surg, 2020, 57(1): 85-91.
12.	吕井井, 施国丞, 刘巍, 等. 1.5 片法与改良单片法纠治完全性房室间隔缺损的病例对照研究. 中国胸心血管外科临床杂志, 2017, 24(5): 350-354.
13.	Cui H, Nie Z, Ou Y, et al. Early and midterm outcomes of a modified single-patch technique for repairing complete atrioventricular septal defect in children and adults. J Card Surg, 2020, 35(1): 75-82.
14.	El-Rassi I, Charafeddine F, Tabbakh A, et al. Surgical repair of complete atrioventricular defect (Nunn technique). Multimed Man Cardiothorac Surg, 2015, 2015: mmv023.
15.	Tagliari AP, Schröder DA, Teixeira Filho G, et al. Results of simplified single-patch repair for complete atrioventricular septal defect. Arq Bras Cardiol, 2013, 100(3): 288-293.
16.	楚军民, 徐海涛, 李守军, 等. 完全性房室间隔缺损修补术后再次手术的早中期结果. 中国分子心脏病学杂志, 2016, 16(1): 1570-1572.
17.	Ugaki S, Khoo NS, Ross DB, et al. Modified single-patch compared with two-patch repair of complete atrioventricular septal defect. Ann Thorac Surg, 2014, 97(2): 666-671.
18.	Nunn GR. Atrioventricular canal: Modified single patch technique. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2007: 28-31.
19.	Suzuki T, Bove EL, Devaney EJ, et al. Results of definitive repair of complete atrioventricular septal defect in neonates and infants. Ann Thorac Surg, 2008, 86(2): 596-602.

1. Jonas RA, 主编. 刘锦纷, 译. 先天性心脏病外科综合治疗学. 第2版. 上海: 世界图书出版公司, 2016. 513-530.
2. Fukushima H, Kosaki K, Sato R, et al. Mechanisms underlying early development of pulmonary vascular obstructive disease in down syndrome: An imbalance in biosynthesis of thromboxane A2 and prostacyclin. Am J Med Genet A, 2010, 152A(8): 1919-1924.
3. Craig B. Atrioventricular septal defect: From fetus to adult. Heart, 2006, 92(12): 1879-1885.
4. Xie O, Brizard CP, d'Udekem Y, et al. Outcomes of repair of complete atrioventricular septal defect in the current era. Eur J Cardiothorac Surg, 2014, 45(4): 610-617.
5. Kogon BE, Butler H, McConnell M, et al. What is the optimal time to repair atrioventricular septal defect and common atrioventricular valvar orifice? Cardiol Young, 2007, 17(4): 356-359.
6. 陈寄梅, 李守军代表国家心血管病专家委员会先天性心脏病专业委员会. 先天性心脏病外科治疗中国专家共识 (六): 完全型房室间隔缺损. 中国胸心血管外科临床杂志, 2020, 27(7): 725-731.
7. 李守军, 高峰, 吴清玉, 等. 完全性房室通道的外科治疗. 中国胸心血管外科临床杂志, 2005, 12(5): 323-325.
8. Wang G, Ma K, Pang K, et al. Modified single repair technique for complete atrioventricular septal defect: A propensity score matching analysis. Pediatr Cardiol, 2020, 41(3): 615-623.
9. Fong LS, Betts K, Bell D, et al. Complete atrioventricular septal defect repair in Australia: Results over 25 years. J Thorac Cardiovasc Surg, 2020, 159(3): 1014-1025 e1018.
10. 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, 2019, 28(3): 427-431.
11. Bell D, Thakeria P, Betts K, et al. Propensity-matched comparison of the long-term outcome of the nunn and two-patch techniques for the repair of complete atrioventricular septal defects. Eur J Cardiothorac Surg, 2020, 57(1): 85-91.
12. 吕井井, 施国丞, 刘巍, 等. 1.5 片法与改良单片法纠治完全性房室间隔缺损的病例对照研究. 中国胸心血管外科临床杂志, 2017, 24(5): 350-354.
13. Cui H, Nie Z, Ou Y, et al. Early and midterm outcomes of a modified single-patch technique for repairing complete atrioventricular septal defect in children and adults. J Card Surg, 2020, 35(1): 75-82.
14. El-Rassi I, Charafeddine F, Tabbakh A, et al. Surgical repair of complete atrioventricular defect (Nunn technique). Multimed Man Cardiothorac Surg, 2015, 2015: mmv023.
15. Tagliari AP, Schröder DA, Teixeira Filho G, et al. Results of simplified single-patch repair for complete atrioventricular septal defect. Arq Bras Cardiol, 2013, 100(3): 288-293.
16. 楚军民, 徐海涛, 李守军, 等. 完全性房室间隔缺损修补术后再次手术的早中期结果. 中国分子心脏病学杂志, 2016, 16(1): 1570-1572.
17. Ugaki S, Khoo NS, Ross DB, et al. Modified single-patch compared with two-patch repair of complete atrioventricular septal defect. Ann Thorac Surg, 2014, 97(2): 666-671.
18. Nunn GR. Atrioventricular canal: Modified single patch technique. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2007: 28-31.
19. Suzuki T, Bove EL, Devaney EJ, et al. Results of definitive repair of complete atrioventricular septal defect in neonates and infants. Ann Thorac Surg, 2008, 86(2): 596-602.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical treatment for complete atrioventricular septal defect in patients above the optimal age

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