title: Surgical interventions for atrioventricular septal defect subtypes: the pediatric heart network experience.
abstract: BACKGROUND
  The influence of atrioventricular septal defect (AVSD) subtype on outcomes after repair is poorly understood.
  
  
  METHODS
  Demographic, procedural, and outcome data were obtained 1 and 6 months after AVSD repair in an observational study conducted at 7 North American centers.
  
  
  RESULTS
  The 215 AVSD patients were subtyped as 60 partial, 27 transitional, 120 complete, and 8 with canal-type VSD. Preoperatively, transitional patients had the highest prevalence of moderate or severe left atrioventricular valve regurgitation (LAVVR, p = 0.01). At repair, complete AVSD and canal-type VSD patients, both with the highest prevalence of trisomy 21 (p < 0.001), were younger (p < 0.001), had lower weight-for-age z scores (p = 0.005), and had more associated cardiac defects (p < 0.001). Annuloplasty was similar among subtypes (p = 0.91), with longer duration of ventilation and hospitalization for complete AVSD (p < 0.001). Independent predictors of moderate or severe LAVVR at the 6-month follow-up were older log(age) at repair (p = 0.02) but not annuloplasty, subtype, or center (p > 0.4). Weight-for-age z scores improved in all subtypes at the 6-month follow-up, and improvement was similar among subtypes (p = 0.17).
  
  
  CONCLUSIONS
  AVSD subtype was significantly associated with patient characteristics and clinical status before repair and influenced age at repair. Significant postoperative LAVVR is the most common sequela, with a similar prevalence across centers 6 months after the intervention. Annuloplasty failed to decrease the postoperative prevalence of moderate or severe LAVVR at 6 months. After accounting for age at repair, AVSD subtype was not associated with postoperative LAVVR severity or growth failure at 6 months. Further investigation is needed to determine if interventional strategies specific to AVSD subtype improve surgical outcomes.
authors.affiliation: Division of Pediatric Cardiothoracic Surgery and Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA. ak.kaza@hsc.utah.edu
authors.forename: Aditya K
authors.initials: AK
authors.lastname: Kaza
authors.forename: Steven D
authors.initials: SD
authors.lastname: Colan
authors.forename: James
authors.initials: J
authors.lastname: Jaggers
authors.forename: Minmin
authors.initials: M
authors.lastname: Lu
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Atz
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Sleeper
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.forename: Linda M
authors.initials: LM
authors.lastname: Lambert
authors.forename: Renee
authors.initials: R
authors.lastname: Margossian
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Lacro
authors.forename: Marc E
authors.initials: ME
authors.lastname: Richmond
authors.forename: Shobha
authors.initials: S
authors.lastname: Natarajan
authors.forename: L Luann
authors.initials: LL
authors.lastname: Minich
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002675:Child, Preschool; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome; D014481:United States; D016277:Ventricular Function, Left