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CC BY 4.0 · Thorac Cardiovasc Surg 2025; 73(S 03): e11-e20
DOI: 10.1055/a-2536-8640
Pediatric and Congenital Cardiology

A 27-Year Experience with Atrioventricular Septal Defect Correction

Mina Farag 
1   Department of Cardiac Surgery, Division of Congenital Cardiac Surgery, Heidelberg University, Congenital, Heidelberg, Germany
,
Mireia Isern Hacker
1   Department of Cardiac Surgery, Division of Congenital Cardiac Surgery, Heidelberg University, Congenital, Heidelberg, Germany
,
Philippe Grieshaber
1   Department of Cardiac Surgery, Division of Congenital Cardiac Surgery, Heidelberg University, Congenital, Heidelberg, Germany
,
Elizabeth Fonseca Escalante
1   Department of Cardiac Surgery, Division of Congenital Cardiac Surgery, Heidelberg University, Congenital, Heidelberg, Germany
,
Matthias Karck
1   Department of Cardiac Surgery, Division of Congenital Cardiac Surgery, Heidelberg University, Congenital, Heidelberg, Germany
,
Raoul Arnold
2   Department of Paediatric Cardiology, Heidelberg University, Congenital, Heidelberg, Germany
,
Matthias Gorenflo
2   Department of Paediatric Cardiology, Heidelberg University, Congenital, Heidelberg, Germany
,
Tsvetomir Loukanov
1   Department of Cardiac Surgery, Division of Congenital Cardiac Surgery, Heidelberg University, Congenital, Heidelberg, Germany
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Abstract

Background

This single-center study investigated long-term outcomes after surgical correction of atrioventricular septal defect (AVSD).

Methods

A total of 248 patients underwent biventricular repair for AVSD between 1995 and 2022. A total of 208 (83.9%) patients had complete (cAVSD), 29 (11.7%) partial (pAVSD), and 11 (4.4%) transitional AVSD (tAVSD). Associated cardiovascular anomalies were present in 88 (35.5%) cases and 61 (24.6%) patients were born prematurely. Median age at repair was 7.1 for cAVSD, 23.7 for pAVSD, and 13 months for tAVSD.

Results

Overall survival or reoperation incidence did not differ significantly between AVSD types and improved significantly over surgical eras. Survival of the entire cohort was 88.3% at 10, 83.8% at 15, and 79.6% at 25 years. Prematurity (hazard ratio [HR]: 2.43, p = 0.029), low weight (<4 kg) (HR: 3.05, p = 0.028), and partial cleft closure (HR: 2.43, p = 0.037) were independent risk factors for mortality. Forty-eight patients (19.4%) underwent a total of 64 reoperations over the study period. The main indication for reoperation was left atrioventricular valve regurgitation (LAVVR) with 55/64 procedures. However, 36% of procedures were performed to address several lesions, with left ventricular outflow tract obstruction being the second most common indication. Freedom from reoperation was 78.2, 75.8, and 72.5% at 10, 15, and 25 years, respectively. The incidence of reoperation increased significantly in association with early postoperative LAVVR ≥ I–II° (HR: 2.6, 95% confidence interval [CI]: 1.4–4.7, p = 0.002) and presence of residual cardiac defects (HR: 2.0, 95% CI: 1.1–3.6, p = 0.018).

Conclusion

While LAVVR is the main indication for reoperation, a significant proportion of procedures address additional pathologies. Premature patients and those with associated cardiovascular anomalies should receive special attention during postoperative follow-up.

Keywords

cardiac - congenital heart disease - heart valve surgery - outcomes (mortality, morbidity) - reoperation

Note

The research presented in this paper was presented as poster presentation at the 8th World Congress of Pediatric Cardiology and Cardiac Surgery in Washington, DC in September 2023.


Supplementary Material



Publication History

Received: 01 November 2024

Accepted: 10 January 2025

Article published online:
28 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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