59. Early and late results of routine leaflet augmentation for complete atrio-ventricular septal defect repair

摘要

Complete AVSD (CAVSD) is characterized by the presence of a common atrio-ventricular (AV) orifice, an inter-atrial communication, and a ventricular septal defect (VSD). Results of surgical correction of atrio-ventricular septal defects (AVSDs) have improved over the last decades; however, the need for reoperation for left atrio-ventricular valve regurgitation, after primary AVSD repair remains a major concern. The aim of our study is to assess the outcome of the routine leaflet augmentation technique in CAVSD repair. A retrospective database and chart review analysis of all patients who underwent AV canal repair at king Abdul-Aziz Cardiac Center during period from 1999 to September 2014 was conducted. Demographic data, associated anomalies, operative data, ICU and hospital course were reviewed. Early outcomes were reviewed for postoperative complications (Chylothorax, complete AV block, Arrhythmias, early mortality) and late outcomes were reviewed for Left AV valve regurgitation requiring for re-intervention and late mortality. Two hundred and sixty patients underwent leaflet augmentation technique to repair complete AVSD, between January 1999 and September 2014. The mean age was (131.5 months), and mean weight (6.06 kg). A variety of concomitant procedures were performed at the time of repair of the CAVSD, including a total of 49 patients (18.8%) who underwent PDA ligation. Repair of TV (Right AV valve) was performed in 11 patients (4.2%), 9 patients (3.46%) required RVOTO resection, in 5 patients (1.92%), PA plasty was done and 2 patients (0.76%) required ECMO after CAVSD repair. Regarding reoperations, a total of 17 patients (of 260) required reoperation after initial CAVSD repair. The most common indication for reoperation was left AV valve regurgitation in 16 patients (6%) in the follow up period up to 15 years. One patient (0.38%) required diaphragmatic plication. The overall mortality was 3 patients (1.1%). Leaflet augmentation for the repair of the complete AVSD, represent a good surgical alternative technique, allows for good exposure, good LAVV reconstruction and close to anatomical repair and results in reduced incidence of late Left atrio-ventricular valve regurgitation.