title: Outcomes and reoperations after total correction of complete atrio-ventricular septal defect.
abstract: BACKGROUND
  Surgical correction of complete atrio-ventricular septal defect (AVSD) achieves satisfactory results with low morbidity and mortality, but may require reoperation. Our recent operative results at mid-term were followed-up.
  
  
  METHODS
  From June 2000 to December 2007, 81 patients (Down syndrome; n=60), median age 4.0 months (range 0.7-118.6) and weight 4.7kg (range 2.2-33), underwent complete AVSD correction. Patch closure for the ventricular septal defect (VSD; n=69) and atrial septal defect (ASD; n=42) was performed with left atrio-ventricular valve (LAVV) cleft closure (n=76) and right atrio-ventricular valve (RAVV) repair (n=57). Mortality, morbidity, and indications for reoperation were retrospectively studied; the end point 'time to reoperation' was analyzed using Kaplan-Meier curves. Follow-up was complete except in two patients and spanned a median of 28 months (range 0.4-6.1 years).
  
  
  RESULTS
  In-hospital mortality was 3.7% (n=3) and one late death occurred. Reoperation was required in 7/79 patients (8.9%) for LAVV insufficiency (n=4), for a residual ASD (n=1), for right atrio-ventricular valve insufficiency (n=1), and for subaortic stenosis (n=1). At last follow-up, no or only mild LAVV and RAVV insufficiency was present in 81.3% and 92.1% of patients, respectively, and 2/3 of patients were medication-free. Risk factors for reoperation were younger age (<3 months; p=0.001) and lower weight (<4kg; p=0.003), and a trend towards less and later reoperations in Down syndrome (p<0.2).
  
  
  CONCLUSIONS
  Surgical correction of AVSD can be achieved with low mortality and need for reoperation, regardless of Down syndrome or not. Immediate postoperative moderate or more residual atrio-ventricular valve insufficiency will eventually require a reoperation, and could be anticipated in patients younger than 3 months and weighing <4kg.
authors.affiliation: Division of Congenital Cardiovascular Surgery, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zürich, Switzerland. ali.dodge-khatami@kispi.uzh.ch
authors.forename: Ali
authors.initials: A
authors.lastname: Dodge-Khatami
authors.forename: Stefan
authors.initials: S
authors.lastname: Herger
authors.forename: Valentin
authors.initials: V
authors.lastname: Rousson
authors.forename: Maurice
authors.initials: M
authors.lastname: Comber
authors.forename: Walter
authors.initials: W
authors.lastname: Knirsch
authors.forename: Urs
authors.initials: U
authors.lastname: Bauersfeld
authors.forename: René
authors.initials: R
authors.lastname: Prêtre
mesh_terms: D000367:Age Factors; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D004314:Down Syndrome / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012086:Reoperation; D016896:Treatment Outcome