title: Reoperations for left atrioventricular valve dysfunction after repair of atrioventricular septal defect.
abstract: OBJECTIVE
  Postoperative left atrioventricular valve (LAVV) dysfunction is known to be the principal risk factor influencing outcome after repair of all types of atrioventricular septal defect (AVSD). The purpose of the present study was to identify the risk factors for reoperation and to assess the outcomes after reoperation for LAVV dysfunction.
  
  
  METHODS
  Records of 412 patients who underwent anatomical repair for different types of AVSD from January 2000 to July 2012 were reviewed. The study group (n = 60) included 13 additional patients for whom repair ± LAVV reoperation was performed in a primary institution. Outcomes, independent risk factors, reoperation and death were analysed.
  
  
  RESULTS
  There were 7 early, (1.7%) and 1 late death. Forty-seven (11.4%) required 64 reoperations for LAVV dysfunction. The median delay for the first LAVV reoperation was 3.5 months (range: 5 days to 10.0 years). Unbalanced ventricles with small left ventricle [odds ratio (OR) = 4.06, 95% confidence interval (CI): 1.58-10.44, P = 0.004], double-orifice LAVV (OR = 5.04, 95% CI: 1.39-18.27, P = 0.014), prior palliative surgery (OR = 3.5, 95% CI: 1.14-10.8, P = 0.029) and discharge echocardiography documenting LAVV regurgitation grade >2 (OR = 21.96, 95% CI: 8.91-54.09, P < 0.001) were found to be independent risk factors for LAVV reoperation. Twelve-year survival and freedom from LAVV reoperation rates were, respectively, 96.1% (95% CI: 94.1-98.1) and 85.8% (95% CI: 81.3-90.3). Survival was significantly worse in patients who underwent LAVV reoperation (P < 0.001) and in those who underwent valve replacement vs valve repair (P = 0.020).
  
  
  CONCLUSIONS
  After AVSD repair, LAVV dysfunction appears to be the principal factor that influences outcome. It can usually be managed by repair. Need for multiple reoperations is not uncommon. Long-term outcome in patients with repaired LAVV is favourable.
authors.affiliation: Department of Pediatric and Congenital Heart Disease, Marie Lannelongue Hospital/M3C, University Paris-Sud, Le Plessis-Robinson, France.
authors.forename: Margaux
authors.initials: M
authors.lastname: Pontailler
authors.forename: David
authors.initials: D
authors.lastname: Kalfa
authors.forename: Enrique
authors.initials: E
authors.lastname: Garcia
authors.forename: Mohamedou
authors.initials: M
authors.lastname: Ly
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Le Bret
authors.forename: Régine
authors.initials: R
authors.lastname: Roussin
authors.forename: Virginie
authors.initials: V
authors.lastname: Lambert
authors.forename: Bertrand
authors.initials: B
authors.lastname: Stos
authors.forename: André
authors.initials: A
authors.lastname: Capderou
authors.forename: Emre
authors.initials: E
authors.lastname: Belli
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006343:Heart Septal Defects / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult
keywords: Atrioventricular septal defect; Congenital; Heart defects; Valve repair