Early repair of complete atrioventricular septal defect is safe and effective.
BACKGROUND
Surgical repair of complete atrioventricular septal defect (CAVSD) is a well-established procedure performed on young children. Our hypothesis is that with modern techniques, the current risks of CAVSD repair in children aged younger than 3 months and in children older than 3 months are equal.


METHODS
This was a retrospective review of 65 infants and children with a mean age of 10.9 months (range, 1 month to 15.5 years) who underwent CAVSD repair from 1990 to 2004. Twenty-six repairs (40%) were done on or before 3 months of age (group A) and 39 repairs (60%) were done after 3 months of age (group B). In all patients, the ventricular septal defect was repaired with an individualized approach according to each patient's specific anatomy: direct suturing without a patch, interposition of a small pericardial patch with a running suture, or both. The atrioventricular commissure was closed with interrupted sutures, and all atrial defects were closed with a pericardial patch. Data were analyzed using the chi2 analysis and the Fisher exact test.


RESULTS
Three hospital deaths occurred (<30 days), 2 in group A and 1 in group B (7.7% vs 2.6%, respectively, p = 0.33). One death in group A occurred during another noncardiac surgery. Early reoperation (<1 year of initial surgery) for residual ventricular septal defect or significant mitral regurgitation, or both, occurred in 3 group A patients and in 4 group B patients (11.5% versus 10.3% respectively, p = 0.68).


CONCLUSIONS
These results suggest that repair of CAVSD defects in children 3 months of age or younger had similar outcomes compared with those who underwent surgical repair after 3 months of age.
Singh
R Ramesh
RR
Department of Surgery, University of Virginia, Charlottesville, Virginia 22908, USA.
Warren
Patrick S
PS
Reece
T Brett
TB
Ellman
Peter
P
Peeler
Benjamin B
BB
Kron
Irving L
IL
D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D006343:Heart Septal Defects / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010496:Pericardium / Q000637:transplantation; D012189:Retrospective Studies; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome