title: A single-centre 37-year experience with reoperation after primary repair of atrioventricular septal defect.
abstract: OBJECTIVE
  To evaluate our experience with patients reoperated after primary repair of atrioventricular septal defect (AVSD) and identify predictors of poor outcome.
  
  
  METHODS
  Between 1976 and 2014, 69 patients were reoperated after primary repair of partial (n = 28), intermediate (n = 15) or complete (n = 26) AVSD.
  
  
  RESULTS
  Median age at first reoperation was 62.4 (range, 1.6-845) months, median interval to first reoperation was 22.3 (range, 0.2-598) months. Main indications for first reoperation included left atrioventricular valve (LAVV) pathology (66%), residual septal defect (19%) and left ventricle outflow tract obstruction (LVOTO; 4%). Procedures to address LAVV pathology included various valvuloplasties in 47 (77%) patients and valve replacement in 14 (23%) patients. A second, third, fourth and fifth reoperation was required in 27, 12, 4 and 1 patient, respectively. Most common procedures were LAVV replacement (LAVVR), LVOTO relief, pacemaker implantation and right atrioventricular valve procedure. Freedom from reoperation after LAVV valvuloplasty (LAVVP) was 84 and 62% at 1 and 10 years, respectively. There were 10 early and 4 late deaths. Estimated overall survival at 1, 5 and 10 years was 87, 83 and 83%, respectively. Double orifice LAVV (DOLAVV) was a risk factor for in-hospital and overall mortality [odds ratio (OR) = 14.5; 95% confidence interval (CI) = 1.2-178.7; P = 0.037 and hazard ratio (HR) = 6.8; 95% CI = 1.5-31.7; P = 0.015, respectively]. Patients with LAVVP and LAVVR differed significantly in overall survival (P = 0.014). At the last follow-up (median, 9.8; range, 0-34 years), 84% survivors were in New York Heart Association Class I or II.
  
  
  CONCLUSIONS
  Many patients reoperated after primary AVSD repair needed surgical reintervention. LAVV pathology was the most common indication for reoperation. DOLAVV was a risk factor for mortality. Particular AVSD type did not appear to be a risk factor for mortality or LAVVP failure. There is some evidence for the close relationship between LAVV pathology and LVOTO in subjects undergoing reoperation after primary AVSD repair as some patients with initial LAVV problems needed LVOTO repair later on and vice versa.
authors: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands v.sojak@lumc.nl.
authors: Vladimir
authors: V
authors: Sojak
authors: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
authors: Marlotte
authors: M
authors: Kooij
authors: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
authors: Aria
authors: A
authors: Yazdanbakhsh
authors: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
authors: Dave R
authors: DR
authors: Koolbergen
authors: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
authors: Eline F
authors: EF
authors: Bruggemans
authors: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
authors: Mark G
authors: MG
authors: Hazekamp
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006343:Heart Septal Defects / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Atrioventricular septal defect; Left ventricle outflow tract obstruction; Reoperation; Risk factors; Valve repair; Valve replacement