title: Early Complete Atrioventricular Canal Repair Yields Outcomes Equivalent to Late Repair.
abstract: BACKGROUND
  Repair of complete atrioventricular canal early in infancy has traditionally carried greater morbidity and mortality than repair performed later. However, an individualized anatomy-based repair may give young infants outcomes that are equivalent to older patients.
  
  
  METHODS
  We retrospectively reviewed 139 patients who underwent complete atrioventricular canal repair from January 2005 to December 2012. An individualized approach was used: 2-patch repair was performed in 98 patients for large ventricular septal defects and a modified single-patch ("Australian technique") was used in 41 for "shallow" ventricular septal defects.
  
  
  RESULTS
  The average age was 25.5 ± 3.9 weeks, 50% were boys, and 78% had trisomy 21. Mean follow-up was 5.1 ± 0.2 years, with 100% completeness of data. There were 3 in-hospital deaths (2.1%) and 1 late death (0.7%). A permanent pacemaker was required in 2 patients (1.4%). The rate for left atrioventricular valve reoperation was 8% at a mean of 211 ± 238 days after the original repair (range, 6 to 682 days). Compared with patients aged older than 3 months, the 39 patients (28%) who were younger than 3 months had similar perioperative courses and rate of reoperation. Compared with patients with an Australian repair, the 98 patients (71%) with a 2-patch repair were more likely to have trisomy 21 and had slightly increased cardiopulmonary bypass and cross-clamp times but similar outcomes. Multivariate analysis showed postoperative left atrioventricular valve regurgitation greater than 2 and left ventricular outflow tract obstruction were significant risk factors for reoperation on the left atrioventricular valve (both p < 0.05).
  
  
  CONCLUSIONS
  Repair of complete atrioventricular canal using an individualized surgical approach yields reoperation and early mortality rates similar for younger infants compared with older infants, obviating the need to delay operation in symptomatic patients.
authors.affiliation: Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Stephens
authors.affiliation: Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Ali N
authors.initials: AN
authors.lastname: Ibrahimiye
authors.affiliation: Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Halit
authors.initials: H
authors.lastname: Yerebakan
authors.affiliation: Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Betul
authors.initials: B
authors.lastname: Yilmaz
authors.affiliation: Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Anjali
authors.initials: A
authors.lastname: Chelliah
authors.affiliation: Cardiology, Columbia University Medical Center, New York, New York.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Levasseur
authors.affiliation: Cardiothoracic Surgery, New York University, New York, New York.
authors.forename: Ralph S
authors.initials: RS
authors.lastname: Mosca
authors.affiliation: Pediatric Cardiovascular Surgery, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Chen
authors.affiliation: Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Paul
authors.initials: P
authors.lastname: Chai
authors.affiliation: Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Jan
authors.initials: J
authors.lastname: Quaegebeur
authors.affiliation: Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, New York. Electronic address: eb2709@cumc.columbia.edu.
authors.forename: Emile A
authors.initials: EA
authors.lastname: Bacha
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D004452:Echocardiography; D004694:Endocardial Cushion Defects / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009518:New York / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome