title: Surgical management of complete atrioventricular septal defect: associations with surgical technique, age, and trisomy 21.
abstract: OBJECTIVE
  We sought to evaluate the contemporary results after repair of a complete atrioventricular septal defect and to determine the factors associated with suboptimal outcomes.
  
  
  METHODS
  The demographic, procedural, and outcome data were obtained within 1 and 6 months after repair of a complete atrioventricular septal defect in 120 children in a multicenter observational study from June 2004 to 2006.
  
  
  RESULTS
  The median age at surgery was 3.7 months (range, 9 days to 1.1 years). The type of surgical repair was a single patch (18%), double patch (72%), and a single atrial septal defect patch with primary ventricular septal defect closure (10%). The incidence of residual septal defects and the degree of left atrioventricular valve regurgitation (LAVVR) did not differ by repair type. The median interval of intensive care stay were 4 days, ventilation use 2 days, and total hospitalization 8 days. All were independent of the presence of trisomy 21 (80% of the cohort). The in-hospital mortality rate was 2.5% (3/120). The overall 6-month mortality rate was 4% (5/120). The presence of associated anomalies and younger age at surgery were independently associated with a longer hospital stay. The age at repair was not associated with residual ventricular septal defect or moderate or greater LAVVR at 6 months. Moderate or greater LAVVR occurred in 22% at 6 months, and the strongest predictor for this was moderate or greater LAVVR at 1 month (odds ratio, 6.9; 95% confidence interval, 2.2-21.7; P < .001).
  
  
  CONCLUSIONS
  The outcomes after repair of complete atrioventricular septal defect did not differ by repair type or the presence of trisomy 21. An earlier age at surgery was associated with increased resource use but had no association with the incidence of residual ventricular septal defect or significant LAVVR.
authors.affiliation: Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, SC 29425, USA. atzam@musc.edu
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Atz
authors.forename: John A
authors.initials: JA
authors.lastname: Hawkins
authors.forename: Minmin
authors.initials: M
authors.lastname: Lu
authors.forename: Meryl S
authors.initials: MS
authors.lastname: Cohen
authors.forename: Steven D
authors.initials: SD
authors.lastname: Colan
authors.forename: James
authors.initials: J
authors.lastname: Jaggers
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Lacro
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.forename: Renee
authors.initials: R
authors.lastname: Margossian
authors.forename: Ralph S
authors.initials: RS
authors.lastname: Mosca
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Sleeper
authors.forename: L LuAnn
authors.initials: LL
authors.lastname: Minich
mesh_terms: D000367:Age Factors; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002170:Canada; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002675:Child, Preschool; D003422:Critical Care; D004314:Down Syndrome / Q000150:complications* / Q000401:mortality; D018618:Echocardiography, Doppler, Color; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors