title: Mid-term outcome with pericardial patch augmentation for redo left atrioventricular valve repair in atrioventricular septal defect†.
abstract: OBJECTIVE
  Recurrent left atrioventricular valve (LAVV) regurgitation after atrioventricular septal defect (AVSD) repair is a difficult technical issue. This study exposes the various techniques successively employed to repair the recurrent LAVV regurgitation and their different outcomes. Emphasis however will be put on the new technique used in our unit called cleft patch augmentation, which has been used continuously since 1998 in the anatomical context of normal papillary muscles (NPMs).
  
  
  METHODS
  This is a retrospective follow-up study using a Cox regression model for risk analyses from November 1991 to July 2008, including 45 patients who underwent reoperation for LAVV regurgitation after AVSD repair. Of those, 3 patients were lost to follow-up; therefore, 42 patients were included in the study. With regard to the AVSD morphology, there were partial AVSD in 12, complete AVSD in 30.
  
  
  RESULTS
  Age at the primary valve repair was 1.5 ± 2.1 years and the time span to the reoperation was 7.1 years in median (0.41-12.3 years). Age at the first reoperation was 10.1 ± 6.8 years. Median follow-up after the reoperation was 7.4 years. Three patients died in the follow-up period. Freedom from second reoperation at 10 years was 72.8% [59.5-89.0% of 95% confidence interval (CI)]. Of 37 patients with NPMs, freedom from reoperation at 10 years was 59.4% (37.2-94.7% 95% CI) in cleft closure group whereas, in the cleft patch augmentation group, it was 92.3% (78.9-100% 95% CI) (P = 0.04). Five patients required valve replacement.
  
  
  CONCLUSIONS
  Surgical result for the redo LAVV repair had good outcomes. In the NPM group, the cleft patch augmentation technique had better results. Various techniques may have to be performed in combination according to the morphological features.
authors: Department of Cardiac Surgery, The Royal Children's Hospital Melbourne, Melbourne, Australia ksughimoto@gmail.com.
authors: Koichi
authors: K
authors: Sughimoto
authors: Department of Cardiac Surgery, The Royal Children's Hospital Melbourne, Melbourne, Australia Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, VIC, Australia Murdoch Childrens Research Institute, Melbourne, Australia.
authors: Yves
authors: Y
authors: d'Udekem
authors: Department of Cardiac Surgery, The Royal Children's Hospital Melbourne, Melbourne, Australia Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, VIC, Australia Murdoch Childrens Research Institute, Melbourne, Australia.
authors: Igor E
authors: IE
authors: Konstantinov
authors: Department of Cardiac Surgery, The Royal Children's Hospital Melbourne, Melbourne, Australia Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, VIC, Australia Murdoch Childrens Research Institute, Melbourne, Australia.
authors: Christian P
authors: CP
authors: Brizard
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006343:Heart Septal Defects / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010496:Pericardium / Q000637:transplantation*; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Atrioventricular septal defect; Congenital heart disease; Valve repair