Results of left atrioventricular valve reoperations following previous repair of atrioventricular septal defects.
OBJECTIVE
We report results of left atrioventricular valve reoperations (LAVVR) following atrioventricular septal defect (AVSD) repair and examine variables predictive of outcome.


METHODS
Multiple demographics and operative variables were analyzed to determine factors affecting survival and reoperation.


RESULTS
Forty patients following partial (n = 9) or complete (n = 31) AVSD repair underwent 47 LAVVR (1992-2005). Median age was 0.87 years (24 days-7.7 years) at initial AVSD repair and 3.15 years (84 days-13.6 years) at subsequent LAVVR with median interval between AVSD repair and LAVVR of 1.76 years (1 day-12.9 years). First LAVVR included repair (n = 20) or replacement (n = 20). Operative mortality was 10% and five-year survival was 76 +/- 6%. Significant risk factors were complete AVSD (p < 0.001), valve replacement (p < 0.001) for early death, and young age at time of LAVVR (p = 0.03) for late death. Five-year freedom from LAVV re-intervention was 100% for replacement versus 55 +/- 13% for repair (p = 0.006). Overall, ejection fraction increased to 61 +/- 3% versus 42 +/- 2% preoperatively (p < 0.01), and left-ventricle end-diastolic dimension Z-score decreased to 0.05 +/- 0.36 versus 3.1 +/- 0.3 preoperatively (p < 0.01). Eighty-seven percent of children were in New York Heart Association class I/II at latest follow-up.


CONCLUSIONS
LAVVR results in significant clinical improvement and lasting recovery in ventricular chamber function and size. Valve repair offers survival advantage and should be aggressively attempted; however, it is only achievable in 50% of cases. Valve replacement is necessary in cases associated with complex LAVV morphology or following repair failure. At intermediate follow-up, patients continue to be at risk of major valve-related morbidity, requirement for re-intervention, and cardiac death.
Alsoufi
Bahaaldin
B
King Faisal Heart Institute, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. balsoufi@hotmail.com
Al-Halees
Zohair
Z
Khouqeer
Fareed
F
Canver
Charles C
CC
Siblini
Ghassan
G
Saad
Elias
E
Sallehuddin
Ahmed
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012529:Saudi Arabia; D013318:Stroke Volume; D013997:Time Factors; D017211:Treatment Failure; D014463:Ultrasonography; D016277:Ventricular Function, Left