Cardiac Function After Tetralogy of Fallot/Complete Atrioventricular Canal Repair.
BACKGROUND
Repair of complete atrioventricular canal (CAVC) with tetralogy of Fallot (TOF) is a challenging operation increasingly being performed as a complete, primary repair in infancy. Previous studies have focused on perioperative outcomes; however, midterm valve function, ventricular function, and residual obstruction have received little attention.


METHODS
We retrospectively reviewed 20 patients who underwent CAVC/TOF repair (January 2005 to December 2014). A two-patch repair was used in all patients to correct the CAVC defect. Tetralogy of Fallot repair included transannular patch in 11 (65%) patients and valve-sparing in 6 (35%) patients.


RESULTS
The average age at surgery was 72 ± 122 weeks, 40% were male, and 80% had trisomy 21. Mean echo follow-up was 3.0 ± 3.0 years. There were no in-hospital or late mortalities. The rate of reoperation was 20%. At the latest follow-up, moderate left atrioventricular valve regurgitation was present in three (15%) patients and mild stenosis present in seven (35%) patients. One (5%) patient had moderate right ventricular outflow tract (RVOT) obstruction. The valve-sparing population was smaller at the time of surgery than the non-valve-sparing cohort (body surface area: 0.28 ± 0.04 vs 0.42 ± 0.11, P = .002) and less likely to have had a previous shunt (0% vs 64%, P = .01). Among the valve-sparing patients (six), at the latest follow-up, moderate pulmonary insufficiency was present in two (33%) patients.


CONCLUSIONS
Repair of CAVC concomitant with TOF can be performed with low mortality and acceptable perioperative morbidity. Management of the RVOT remains a challenge for the long term.
1 Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY, USA.
Elizabeth H
EH
Stephens
2 Division of Cardiology, St Christopher's Hospital for Children, Philadelphia, PA, USA.
Jennifer
J
Tingo
1 Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY, USA.
Marc
M
Najjar
3 Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
Betul
B
Yilmaz
4 Division of Pediatric Cardiology, Columbia University Medical Center, New York, NY, USA.
Stéphanie
S
Levasseur
5 Division of Cardiology, Cornell University, New York, NY, USA.
Jeffrey D
JD
Dayton
6 Department of Cardiothoracic Surgery, New York University, New York, NY, USA.
Ralph S
RS
Mosca
1 Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY, USA.
Paul
P
Chai
1 Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY, USA.
Jan M
JM
Quaegebeur
1 Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY, USA.
Emile A
EA
Bacha
D006348:Cardiac Surgical Procedures / Q000379:methods*; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006343:Heart Septal Defects; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D008297:Male; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D016276:Ventricular Function / Q000502:physiology*
atrioventricular septal defect (AVSD); common atrioventricular canal defect; echocardiography; morbidity); outcomes (includes mortality