title: Long-term outcomes after surgical repair of complete atrioventricular septal defect.
abstract: Survival after surgical repair for complete atrioventricular septal defect (CAVSD) has improved, but patients are at risk for reoperation to address left atrioventricular valve regurgitation and left ventricular outflow tract obstruction. We examined the long-term survival, need for reoperation, and associated risk factors after CAVSD repair at our institution.
  
  
  
  Between 1974 and 2000, a total of 198 patients underwent surgical repair for CAVSD. Of these, 178 patients survived to hospital discharge, of whom 153 (86%) had available follow-up data at a median postoperative time point of 17.2 years (range: 2 months to 38.1 years).
  
  
  
  Overall perioperative mortality was 10.1%, with a significant decrease to 2.9% in the late surgical era: 1991 to 2000 (P < .001). The overall estimated survival for the entire cohort was 85% at 10 years, 82% at 20 years, and 71% at 30 years after initial CAVSD repair. Requiring a reoperation after initial CAVSD repair was a risk factor for late mortality (P = .04). The estimated freedom from reoperation was 88% at 10 years, 83% at 20 years, and 78% at 30 years after initial CAVSD repair. Indications for reoperation included left atrioventricular valve regurgitation in 14 patients (7.1%) and left ventricular outflow obstruction in 7 patients (3.5%).
  
  
  
  Long-term survival after repair of CAVSD remains good. However, the need for reoperation is common and affects long-term survival after CAVSD repair.
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis. Electronic address: sginde@chw.org.
authors.forename: Salil
authors.initials: S
authors.lastname: Ginde
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Janna
authors.initials: J
authors.lastname: Lam
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Garick D
authors.initials: GD
authors.lastname: Hill
authors.affiliation: Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Scott
authors.initials: S
authors.lastname: Cohen
authors.affiliation: Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Woods
authors.affiliation: Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Mitchell
authors.affiliation: Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: James S
authors.initials: JS
authors.lastname: Tweddell
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis; Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Earing
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006343:Heart Septal Defects; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014922:Wisconsin
keywords: Atrioventricular septal defect; adult congenital heart disease; endocardial cushion defect; mitral insufficiency; subaortic stenosis