Reoperation for left atrioventricular valve regurgitation after repair of atrioventricular septal defect

  • Dr Witold Pietrzykowski, Department of Cardiac Surgery, Polish Mother's Memorial Hospital-Research Institute, Poland
  • Prof Jadwiga Moll, Department of Cardiology, Polish Mother's Memorial Hospital-Research Institute, Poland
  • Dr Maciej Moll, Department of Cardiac Surgery, Polish Mother's Memorial Hospital-Research Institute, Poland
  • Dr Marek Kopala, Department of Cardiac Surgery, Polish Mother's Memorial Hospital-Research Institute, Poland
  • Dr Piotr Jarosik, Department of Cardiac Surgery, Polish Mother's Memorial Hospital-Research Institute, Poland
  • Prof Jacek Moll, Department of Cardiac Surgery, Polish Mother's Memorial Hospital-Research Institute, Poland

    • Objectives: Significant left atrioventricular valve regurgitation (LAVVR) after atrioventricular septal defect (AVSD) requires a reparative approach, finally valve replacement.
    Aim of the study: Determine the outcomes of reoperations of LAVVR.
    Methods: Between 1991-2008 we operated on 283 infants with complete form of AVSD (mean aged 4,3 months). Down’s syndrome (DS) was diagnosed in 215 patients (76%). Overall hospital mortality after AVSD repair was 8,8%, the lowest in patients operated in second month of age (4,6%).
    Results: 13 patients (mean age 3,4 months) underwent first reoperation. There were 7 patients non-DS, 10,3% of all non-DS and 6 DS patients, 2,8% of all DS (p<0,05). Interval to reoperation was 1 week to 34 months (mean 10, median 5 months). In all patients partial clefts closures were performed (also Alfieri plasty in 1).
    Second reoperation, i.e. valve replacement was required in 5 patients, 3 non-DS and 2 DS. Interval from first reoperation was 3 weeks to 6 months (mean 2,6, median 2 months). Significantly higher need for replacement was in non-DS (4,4%) than in DS patients (0,9%) (p<0,05).
    There was 1 hospital death after valve repair (patient underwent previously operation for oesophageal atresia). There were 4 hospital deaths after valve replacement, 3 in non-DS patients and 1 in DS patient. Definitive hospital mortality in reoperated patients was 5/13 = 38,5%. Remaining patients had moderate or mild LAVVR and were clinically asymptomatic.
    Conclusion: In this series non-DS patients had a significantly higher need for LAVVR reoperations and higher risk for complication after LAVV replacement.