Surgical management of complete atrioventricular septal defects. A twenty-year experience

Ko Bando, Mark Turrentine, Kyung Sun, Thomas G. Sharp, Gregory J. Ensing, Andrew P. Miller, Kenneth Kesler, Robert S. Binford, Glenn N. Carlos, Roger A. Hurwitz, Randall L. Caldwell, Robert K. Darragh, Joyce Hubbard, Timothy M. Cordes, Donald A. Girod, Harold King, John Brown

Research output: Contribution to journalArticle

116 Citations (Scopus)

Abstract

Creation of a competent left atrioventricular valve is a cornerstone in surgical repair of complete atrioventricular septal defects. To identify risk factors for mortality and failure of left atrioventricular valve repair and to determine the impact of cleft closure on postoperative atrioventricular valve function, we retrospectively analyzed hospital records of 203 patients between January 1974 and January 1995. Overall early mortality was 7.9%. Operative mortality decreased significantly over the period of the study from 19% (4/21) before 1980 to 3% (2/67) after 1990 ( p = 0.03). Ten-year survival including operative mortality was 91.3% ±0.004% (95% confidence limit): all survivors are in New York Heart Association class I or II. Preoperative atrioventricular valve regurgitation was assessed in 203 patients by angiography or echocardiography and was trivial or mild in 103 (52%), moderate in 82 (41%), and severe in 18 (8%). Left atrioventricular valve cleft was closed in 93% (189/203) but left alone when valve leaflet tissue was inadequate and closure of the cleft might cause significant stenosis. Reoperation for severe postoperative left atrioventricular valve regurgitation was necessary in eight patients, five of whom initially did not have closure of the cleft and three of whom had cleft closure. Six patients had reoperation with annuloplasty and two patients required left atrioventricular valve replacement. Five patients survived reoperation and are currently in New York Heart Association class I or II. On most recent evaluation assessed by angiography or echocardiography (a mean of 59 months after repair), left atrioventricular valve regurgitation was trivial or mild in 137 of the 146 survivors (94%) examined; none had moderate or severe left atrioventricular valve stenosis. By multiple logistic regression analysis, strong risk factors for early death and need for reoperation included postoperative pulmonary hypertensive crisis, immediate postoperative severe left atrioventricular valve regurgitation, and double-orifice left atrioventricular valve. These results indicate that complete atrioventricular septal defects can be repaired with low mortality and good intermediate to long-term results. Routine approximation of the cleft is safe and has a low incidence of reoperation for left atrioventricular valve regurgitation. (J THORAC CARDIOVASC SURG 1995;110:1543-54).

Original languageEnglish
Pages (from-to)1543-1554
Number of pages12
JournalJournal of Thoracic and Cardiovascular Surgery
Volume110
Issue number5
DOIs
StatePublished - 1995
Externally publishedYes

Fingerprint

Reoperation
Mortality
Survivors
Echocardiography
Angiography
Pathologic Constriction
Hospital Records
Complete atrioventricular septal defect
Logistic Models
Regression Analysis
Lung
Survival
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Surgical management of complete atrioventricular septal defects. A twenty-year experience. / Bando, Ko; Turrentine, Mark; Sun, Kyung; Sharp, Thomas G.; Ensing, Gregory J.; Miller, Andrew P.; Kesler, Kenneth; Binford, Robert S.; Carlos, Glenn N.; Hurwitz, Roger A.; Caldwell, Randall L.; Darragh, Robert K.; Hubbard, Joyce; Cordes, Timothy M.; Girod, Donald A.; King, Harold; Brown, John.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 110, No. 5, 1995, p. 1543-1554.

Research output: Contribution to journalArticle

Bando, K, Turrentine, M, Sun, K, Sharp, TG, Ensing, GJ, Miller, AP, Kesler, K, Binford, RS, Carlos, GN, Hurwitz, RA, Caldwell, RL, Darragh, RK, Hubbard, J, Cordes, TM, Girod, DA, King, H & Brown, J 1995, 'Surgical management of complete atrioventricular septal defects. A twenty-year experience', Journal of Thoracic and Cardiovascular Surgery, vol. 110, no. 5, pp. 1543-1554. https://doi.org/10.1016/S0022-5223(95)70078-1
Bando, Ko ; Turrentine, Mark ; Sun, Kyung ; Sharp, Thomas G. ; Ensing, Gregory J. ; Miller, Andrew P. ; Kesler, Kenneth ; Binford, Robert S. ; Carlos, Glenn N. ; Hurwitz, Roger A. ; Caldwell, Randall L. ; Darragh, Robert K. ; Hubbard, Joyce ; Cordes, Timothy M. ; Girod, Donald A. ; King, Harold ; Brown, John. / Surgical management of complete atrioventricular septal defects. A twenty-year experience. In: Journal of Thoracic and Cardiovascular Surgery. 1995 ; Vol. 110, No. 5. pp. 1543-1554.
@article{d34828f19ed54d64a53f2e930c2183bf,
title = "Surgical management of complete atrioventricular septal defects. A twenty-year experience",
abstract = "Creation of a competent left atrioventricular valve is a cornerstone in surgical repair of complete atrioventricular septal defects. To identify risk factors for mortality and failure of left atrioventricular valve repair and to determine the impact of cleft closure on postoperative atrioventricular valve function, we retrospectively analyzed hospital records of 203 patients between January 1974 and January 1995. Overall early mortality was 7.9{\%}. Operative mortality decreased significantly over the period of the study from 19{\%} (4/21) before 1980 to 3{\%} (2/67) after 1990 ( p = 0.03). Ten-year survival including operative mortality was 91.3{\%} ±0.004{\%} (95{\%} confidence limit): all survivors are in New York Heart Association class I or II. Preoperative atrioventricular valve regurgitation was assessed in 203 patients by angiography or echocardiography and was trivial or mild in 103 (52{\%}), moderate in 82 (41{\%}), and severe in 18 (8{\%}). Left atrioventricular valve cleft was closed in 93{\%} (189/203) but left alone when valve leaflet tissue was inadequate and closure of the cleft might cause significant stenosis. Reoperation for severe postoperative left atrioventricular valve regurgitation was necessary in eight patients, five of whom initially did not have closure of the cleft and three of whom had cleft closure. Six patients had reoperation with annuloplasty and two patients required left atrioventricular valve replacement. Five patients survived reoperation and are currently in New York Heart Association class I or II. On most recent evaluation assessed by angiography or echocardiography (a mean of 59 months after repair), left atrioventricular valve regurgitation was trivial or mild in 137 of the 146 survivors (94{\%}) examined; none had moderate or severe left atrioventricular valve stenosis. By multiple logistic regression analysis, strong risk factors for early death and need for reoperation included postoperative pulmonary hypertensive crisis, immediate postoperative severe left atrioventricular valve regurgitation, and double-orifice left atrioventricular valve. These results indicate that complete atrioventricular septal defects can be repaired with low mortality and good intermediate to long-term results. Routine approximation of the cleft is safe and has a low incidence of reoperation for left atrioventricular valve regurgitation. (J THORAC CARDIOVASC SURG 1995;110:1543-54).",
author = "Ko Bando and Mark Turrentine and Kyung Sun and Sharp, {Thomas G.} and Ensing, {Gregory J.} and Miller, {Andrew P.} and Kenneth Kesler and Binford, {Robert S.} and Carlos, {Glenn N.} and Hurwitz, {Roger A.} and Caldwell, {Randall L.} and Darragh, {Robert K.} and Joyce Hubbard and Cordes, {Timothy M.} and Girod, {Donald A.} and Harold King and John Brown",
year = "1995",
doi = "10.1016/S0022-5223(95)70078-1",
language = "English",
volume = "110",
pages = "1543--1554",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - Surgical management of complete atrioventricular septal defects. A twenty-year experience

AU - Bando, Ko

AU - Turrentine, Mark

AU - Sun, Kyung

AU - Sharp, Thomas G.

AU - Ensing, Gregory J.

AU - Miller, Andrew P.

AU - Kesler, Kenneth

AU - Binford, Robert S.

AU - Carlos, Glenn N.

AU - Hurwitz, Roger A.

AU - Caldwell, Randall L.

AU - Darragh, Robert K.

AU - Hubbard, Joyce

AU - Cordes, Timothy M.

AU - Girod, Donald A.

AU - King, Harold

AU - Brown, John

PY - 1995

Y1 - 1995

N2 - Creation of a competent left atrioventricular valve is a cornerstone in surgical repair of complete atrioventricular septal defects. To identify risk factors for mortality and failure of left atrioventricular valve repair and to determine the impact of cleft closure on postoperative atrioventricular valve function, we retrospectively analyzed hospital records of 203 patients between January 1974 and January 1995. Overall early mortality was 7.9%. Operative mortality decreased significantly over the period of the study from 19% (4/21) before 1980 to 3% (2/67) after 1990 ( p = 0.03). Ten-year survival including operative mortality was 91.3% ±0.004% (95% confidence limit): all survivors are in New York Heart Association class I or II. Preoperative atrioventricular valve regurgitation was assessed in 203 patients by angiography or echocardiography and was trivial or mild in 103 (52%), moderate in 82 (41%), and severe in 18 (8%). Left atrioventricular valve cleft was closed in 93% (189/203) but left alone when valve leaflet tissue was inadequate and closure of the cleft might cause significant stenosis. Reoperation for severe postoperative left atrioventricular valve regurgitation was necessary in eight patients, five of whom initially did not have closure of the cleft and three of whom had cleft closure. Six patients had reoperation with annuloplasty and two patients required left atrioventricular valve replacement. Five patients survived reoperation and are currently in New York Heart Association class I or II. On most recent evaluation assessed by angiography or echocardiography (a mean of 59 months after repair), left atrioventricular valve regurgitation was trivial or mild in 137 of the 146 survivors (94%) examined; none had moderate or severe left atrioventricular valve stenosis. By multiple logistic regression analysis, strong risk factors for early death and need for reoperation included postoperative pulmonary hypertensive crisis, immediate postoperative severe left atrioventricular valve regurgitation, and double-orifice left atrioventricular valve. These results indicate that complete atrioventricular septal defects can be repaired with low mortality and good intermediate to long-term results. Routine approximation of the cleft is safe and has a low incidence of reoperation for left atrioventricular valve regurgitation. (J THORAC CARDIOVASC SURG 1995;110:1543-54).

AB - Creation of a competent left atrioventricular valve is a cornerstone in surgical repair of complete atrioventricular septal defects. To identify risk factors for mortality and failure of left atrioventricular valve repair and to determine the impact of cleft closure on postoperative atrioventricular valve function, we retrospectively analyzed hospital records of 203 patients between January 1974 and January 1995. Overall early mortality was 7.9%. Operative mortality decreased significantly over the period of the study from 19% (4/21) before 1980 to 3% (2/67) after 1990 ( p = 0.03). Ten-year survival including operative mortality was 91.3% ±0.004% (95% confidence limit): all survivors are in New York Heart Association class I or II. Preoperative atrioventricular valve regurgitation was assessed in 203 patients by angiography or echocardiography and was trivial or mild in 103 (52%), moderate in 82 (41%), and severe in 18 (8%). Left atrioventricular valve cleft was closed in 93% (189/203) but left alone when valve leaflet tissue was inadequate and closure of the cleft might cause significant stenosis. Reoperation for severe postoperative left atrioventricular valve regurgitation was necessary in eight patients, five of whom initially did not have closure of the cleft and three of whom had cleft closure. Six patients had reoperation with annuloplasty and two patients required left atrioventricular valve replacement. Five patients survived reoperation and are currently in New York Heart Association class I or II. On most recent evaluation assessed by angiography or echocardiography (a mean of 59 months after repair), left atrioventricular valve regurgitation was trivial or mild in 137 of the 146 survivors (94%) examined; none had moderate or severe left atrioventricular valve stenosis. By multiple logistic regression analysis, strong risk factors for early death and need for reoperation included postoperative pulmonary hypertensive crisis, immediate postoperative severe left atrioventricular valve regurgitation, and double-orifice left atrioventricular valve. These results indicate that complete atrioventricular septal defects can be repaired with low mortality and good intermediate to long-term results. Routine approximation of the cleft is safe and has a low incidence of reoperation for left atrioventricular valve regurgitation. (J THORAC CARDIOVASC SURG 1995;110:1543-54).

UR - http://www.scopus.com/inward/record.url?scp=0028892803&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028892803&partnerID=8YFLogxK

U2 - 10.1016/S0022-5223(95)70078-1

DO - 10.1016/S0022-5223(95)70078-1

M3 - Article

VL - 110

SP - 1543

EP - 1554

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 5

ER -