Abstract 4568: Surgical Management of Complete Atrioventricular Septal Defect: Associations with Surgical Technique, Age and Trisomy 21

Abstract

Background: Surgical strategies vary for repair of complete atrioventricular septal defect (AVSD). The impact of age, surgical technique and trisomy 21 on contemporary outcomes is poorly defined. Methods: From 6/04 to 2/06, 124 children with primary repair of complete AVSD were studied in a Pediatric Heart Network sponsored observational study. Demographic, procedural, and outcome data were obtained within 28 days of surgery and 6 months later. Results: Median age at repair was 115 days (9 – 396 days). Type of surgical repair was single patch (19%), double patch (71%), and single ASD patch with primary VSD closure (10%). Repair types varied significantly across centers (p=0.002) but there were no differences noted in residual atrial or ventricular septal defects or degree of mitral regurgitation (MR) by repair type within 28 days. Median intensive care unit (ICU) stay was 4 days, length of ventilation 2 days, total hospital stay 7 days; there were no differences by presence of trisomy 21(80% of cohort). A patch margin VSD was detected by echo within 28 days in 43% and at 6 months in 14% (p<0.05). A VSD > 3mm was seen in 6% at discharge and 1% at 6 months. At least moderate MR was present in 26% early and 22% at 6 months. Hospital mortality was 3/124 (2.4%); one within 30 days (0.8%). Overall survival at 6 months was 96% (119/124). Pleural effusion was the most common reported postoperative complication (20%). Earlier age at surgery was associated with longer time on ventilator (p=0.02), longer ICU stay (p=0.03) and use of circulatory arrest (p=0.01). Older age was associated with longer duration of aortic cross clamp time (p=0.05). Age at repair was not associated with residual abnormalities including residual VSD and moderate or greater MR at 6 months. . Conclusions: Contemporary outcomes following repair of complete AVSD are excellent regardless of repair type or presence of trisomy 21. Although a residual VSD may be detected by echo in 43%, most are trivial and resolve by 6 months. Earlier age at surgery is associated with increased resource utilization but has no influence on incidence of residual VSD or significant MR.