title: Modified single-patch compared with two-patch repair of complete atrioventricular septal defect.
abstract: BACKGROUND
  We compared the outcomes of modified single-patch and two-patch surgical repair of complete atrioventricular septal defect (CAVSD) on left ventricular outflow tract (LVOT) diameter and on left atrioventricular valve (LAVV) coaptation.
  
  
  METHODS
  We reviewed retrospectively postoperative 2-dimensional echocardiograms of all CAVSD patients who underwent modified single-patch or two-patch repair between 2005 and 2011. We measured the leaflet coaptation length of the LAVV in the apical four-chamber view. The LVOT was measured in the long axis view.
  
  
  RESULTS
  Fifty-one patients underwent CAVSD repair at a median age of 4 months (range, 1 to 9 months) (single-patch, n=29; two-patch, n=22). The images from 46 echocardiograms were adequate for analysis. Modified single-patch repair required significantly shorter bypass time (102.0±33.6 vs 152.9±39.5 minutes, p<0.001) and ischemic time (69.0±21.7 vs 106.9±29.7 minutes, p<0.001) than did two-patch repair. The indexed coaptation length of the septal and lateral leaflets was not different between single-patch and two-patch (3.1±2.3 vs 4.1±3.1 mm/m2, p=0.25; 2.3±2.3 vs 3.3±3.0 mm/m2, p=0.21). Indexed LVOT diameter was not different in the two groups (26.1±5.2 vs 28.5±7.1 mm/m2, p=0.22). There was no hospital or late death during the median follow-up time of 35 months (range, 1 to 69 months). Five patients underwent reoperation after single-patch repair (3 with residual ventricular septal defect [VSD] and LAVV regurgitation, 1 with residual VSD, 1 with pacemaker implantation). After the two-patch repair, 1 patient required reoperation for a residual VSD and right atrioventricular valve regurgitation (p=0.22).
  
  
  CONCLUSIONS
  The modified single-patch repair was performed with significantly shorter bypass time and myocardial ischemic time. The postoperative LVOT diameter and LAVV leaflet coaptation length were not significantly different between techniques.
authors.affiliation: Division of Pediatric Cardiac Surgery, Cardiology and Critical Care, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Shinya
authors.initials: S
authors.lastname: Ugaki
authors.affiliation: Division of Pediatric Cardiac Surgery, Cardiology and Critical Care, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Nee S
authors.initials: NS
authors.lastname: Khoo
authors.affiliation: Division of Pediatric Cardiac Surgery, Cardiology and Critical Care, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: David B
authors.initials: DB
authors.lastname: Ross
authors.affiliation: Division of Pediatric Cardiac Surgery, Cardiology and Critical Care, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Rebeyka
authors.affiliation: Division of Pediatric Cardiac Surgery, Cardiology and Critical Care, Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. Electronic address: iadatia@ualberta.ca.
authors.forename: Ian
authors.initials: I
authors.lastname: Adatia
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006343:Heart Septal Defects; D006352:Heart Ventricles / Q000033:anatomy & histology; D006801:Humans; D007223:Infant; D008297:Male; D008943:Mitral Valve / Q000502:physiology; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: 21