Reoperation for severe left atrioventricular regurgitation by standardized mitral repair-oriented strategy in complete atrioventricular septal defect patients_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

DOI：

10.7507/1007-4848.202005025

Video：

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Objective To summarize the reoperation experience for complete atrioventricular septal defect (CAVSD) with severe left atrioventricular valve regurgitation (LAVVR) by standardized mitral repair-oriented strategy.Methods From 2016 to 2019, 11 CAVSD patients underwent reoperation for severe LAVVR by standardized mitral repair-oriented strategy at Fuwai Hospital, including 5 males and 6 females with a median age of 56 (22-152) months. The pathological characteristics of severe LAVVR, key points of repair technique and mid-term follow-up results were analyzed.Results The interval time between the initial surgery and this surgery was 48 (8-149) months. The aortic cross-clamp time was 54.6±21.5 min and the cardiopulmonary bypass time was 107.4±38.1 min, ventilator assistance time was 16.4±16.3 h. All patients recovered smoothly with no early or late death. The patients were followed up for 29.0±12.8 months, and the echocardiograph showed trivial to little mitral regurgitation in 5 patients, little regurgitation in 5 patients and moderate regurgitation in 1 patient. The classification (NYHA) of cardiac function was class Ⅰ in all patients.Conclusion Standardized mitral repair-oriented strategy is safe and effective in the treatment of severe LAVVR after CAVSD surgery, and the mid-term results are satisfied.

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. Reoperation for severe left atrioventricular regurgitation by standardized mitral repair-oriented strategy in complete atrioventricular septal defect patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(8): 959-962. doi: 10.7507/1007-4848.202005025 Copy

1.	张本青, 龚丁旭, 焦若男, 等. 先天性二尖瓣关闭不全患儿成形手术近中期结果分析. 中国循环杂志, 2020, 35(5): 500-504.
2.	Qi L, Ma K, Zhang B, et al. Pediatric mitral regurgitation: Standardized repair-oriented strategy with leaflet plication. Semin Thorac Cardiovasc Surg, 2020. [Epub ahead of print].
3.	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.
4.	Geoffrion TR, Singappuli K, Murala JSK. A review of the Nunn modified single patch technique for atrioventricular septal defect repair. Transl Pediatr, 2018, 7(2): 91-103.
5.	Tagliari AP, Schroder 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.
6.	黄健兵, 梅举, 张俊文, 等. 房室间隔缺损矫治术后左侧房室瓣反流的外科治疗. 中国心血管病研究, 2018, 16(9): 829-832.
7.	Birim O, van Gameren M, de Jong PL, et al. Outcome after reoperation for atrioventricular septal defect repair. Interact Cardiovasc Thorac Surg, 2009, 9(1): 83-87.
8.	于冰, 杨克明, 李轩, 等. 48例儿童二尖瓣置换术的中远期结果. 中华胸心血管外科杂志, 2016, 32(12): 750-753.
9.	刘浩, 梅举, 汤敏, 等. 儿童心瓣膜置换术患者的临床特点及中远期随访. 中国胸心血管外科临床杂志, 2015, 22(5): 446-449.
10.	栾果, 安永. 二尖瓣成形术治疗儿童二尖瓣关闭不全的研究进展. 重庆医学, 2019, 48(12): 2099-2101, 2106.
11.	陈俊, 孙剑, 彭卫, 等. 小儿二尖瓣关闭不全瓣膜成形术的临床疗效分析. 临床小儿外科杂志, 2020, 19(6): 513-517.
12.	Ten Harkel AD, Cromme-Dijkhuis AH, Heinerman BC, et al. Development of left atrioventricular valve regurgitation after correction of atrioventricular septal defect. Ann Thorac Surg, 2005, 79(2): 607-612.
13.	Fortuna RS, Ashburn DA, Carias De Oliveira N, et al. Atrioventricular septal defects: Effect of bridging leaflet division on early valve function. Ann Thorac Surg, 2004, 77(3): 895-902.
14.	Kanani M, Elliott M, Cook A, et al. Late incompetence of the left atrioventricular valve after repair of atrioventricular septal defects: The morphologic perspective. J Thorac Cardiovasc Surg, 2006, 132(3): 640-646.
15.	Yakub MA, Krishna Moorthy PS, Sivalingam S, et al. Contemporary long-term outcomes of an aggressive approach to mitral valve repair in children: Is it effective and durable for both congenital and acquired mitral valve lesions? Eur J Cardiothorac Surg, 2016, 49(2): 553-560.
16.	Kalfa D, Vergnat M, Ly M, et al. A standardized repair-oriented strategy for mitral insufficiency in infants and children: Midterm functional outcomes and predictors of adverse events. J Thorac Cardiovasc Surg, 2014, 148(4): 1459-1466.
17.	Backer CL, Mavroudis C, Alboliras ET, et al. Repair of complete atrioventricular canal defects: Results with the two-patch technique. Ann Thorac Surg, 1995, 60(3): 530-537.
18.	Prifti E, Bonacchi M, Baboci A, et al. Surgical outcome of reoperation due to left atrioventricular valve regurgitation after previous correction of complete atrioventricular septal defect. J Card Surg, 2013, 28(6): 756-763.
19.	Najm HK, Coles JG, Endo M, et al. Complete atrioventricular septal defects: Results of repair, risk factors, and freedom from reoperation. Circulation, 1997, 96(9 Suppl): 311-315.
20.	Moran AM, Daebritz S, Keane JF, et al. Surgical management of mitral regurgitation after repair of endocardial cushion defects: Early and midterm results. Circulation, 2000, 102(19 Suppl 3): 160-165.
21.	Alexi-Meskishvili V, Hetzer R, Dahnert I, et al. Results of left atrioventricular valve reconstruction after previous correction of atrioventricular septal defects. Eur J Cardiothorac Surg, 1997, 12(3): 460-465.
22.	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. 中国分子心脏学杂志, 2016, 16(1): 1570-1572.

1. 张本青, 龚丁旭, 焦若男, 等. 先天性二尖瓣关闭不全患儿成形手术近中期结果分析. 中国循环杂志, 2020, 35(5): 500-504.
2. Qi L, Ma K, Zhang B, et al. Pediatric mitral regurgitation: Standardized repair-oriented strategy with leaflet plication. Semin Thorac Cardiovasc Surg, 2020. [Epub ahead of print].
3. 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.
4. Geoffrion TR, Singappuli K, Murala JSK. A review of the Nunn modified single patch technique for atrioventricular septal defect repair. Transl Pediatr, 2018, 7(2): 91-103.
5. Tagliari AP, Schroder 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.
6. 黄健兵, 梅举, 张俊文, 等. 房室间隔缺损矫治术后左侧房室瓣反流的外科治疗. 中国心血管病研究, 2018, 16(9): 829-832.
7. Birim O, van Gameren M, de Jong PL, et al. Outcome after reoperation for atrioventricular septal defect repair. Interact Cardiovasc Thorac Surg, 2009, 9(1): 83-87.
8. 于冰, 杨克明, 李轩, 等. 48例儿童二尖瓣置换术的中远期结果. 中华胸心血管外科杂志, 2016, 32(12): 750-753.
9. 刘浩, 梅举, 汤敏, 等. 儿童心瓣膜置换术患者的临床特点及中远期随访. 中国胸心血管外科临床杂志, 2015, 22(5): 446-449.
10. 栾果, 安永. 二尖瓣成形术治疗儿童二尖瓣关闭不全的研究进展. 重庆医学, 2019, 48(12): 2099-2101, 2106.
11. 陈俊, 孙剑, 彭卫, 等. 小儿二尖瓣关闭不全瓣膜成形术的临床疗效分析. 临床小儿外科杂志, 2020, 19(6): 513-517.
12. Ten Harkel AD, Cromme-Dijkhuis AH, Heinerman BC, et al. Development of left atrioventricular valve regurgitation after correction of atrioventricular septal defect. Ann Thorac Surg, 2005, 79(2): 607-612.
13. Fortuna RS, Ashburn DA, Carias De Oliveira N, et al. Atrioventricular septal defects: Effect of bridging leaflet division on early valve function. Ann Thorac Surg, 2004, 77(3): 895-902.
14. Kanani M, Elliott M, Cook A, et al. Late incompetence of the left atrioventricular valve after repair of atrioventricular septal defects: The morphologic perspective. J Thorac Cardiovasc Surg, 2006, 132(3): 640-646.
15. Yakub MA, Krishna Moorthy PS, Sivalingam S, et al. Contemporary long-term outcomes of an aggressive approach to mitral valve repair in children: Is it effective and durable for both congenital and acquired mitral valve lesions? Eur J Cardiothorac Surg, 2016, 49(2): 553-560.
16. Kalfa D, Vergnat M, Ly M, et al. A standardized repair-oriented strategy for mitral insufficiency in infants and children: Midterm functional outcomes and predictors of adverse events. J Thorac Cardiovasc Surg, 2014, 148(4): 1459-1466.
17. Backer CL, Mavroudis C, Alboliras ET, et al. Repair of complete atrioventricular canal defects: Results with the two-patch technique. Ann Thorac Surg, 1995, 60(3): 530-537.
18. Prifti E, Bonacchi M, Baboci A, et al. Surgical outcome of reoperation due to left atrioventricular valve regurgitation after previous correction of complete atrioventricular septal defect. J Card Surg, 2013, 28(6): 756-763.
19. Najm HK, Coles JG, Endo M, et al. Complete atrioventricular septal defects: Results of repair, risk factors, and freedom from reoperation. Circulation, 1997, 96(9 Suppl): 311-315.
20. Moran AM, Daebritz S, Keane JF, et al. Surgical management of mitral regurgitation after repair of endocardial cushion defects: Early and midterm results. Circulation, 2000, 102(19 Suppl 3): 160-165.
21. Alexi-Meskishvili V, Hetzer R, Dahnert I, et al. Results of left atrioventricular valve reconstruction after previous correction of atrioventricular septal defects. Eur J Cardiothorac Surg, 1997, 12(3): 460-465.
22. 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. 中国分子心脏学杂志, 2016, 16(1): 1570-1572.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Reoperation for severe left atrioventricular regurgitation by standardized mitral repair-oriented strategy in complete atrioventricular septal defect patients

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