Background: Short and long-term surgical outcomes of repaired complete atrioventricular septal defects (CAVSD) were described. The rates of survival and freedom from reoperation were determined and the risk factors of surgical outcomes were evaluated in Kuwait.

Methods: Between January 1992 and December 2007, 140 consecutive patients with CAVSD have been surgically managed. Of which 113 (80.7%) underwent primary repair, 18 (12.9%) were debanded and repaired and 9 (6.4%) had additional Tetralogy of Fallot correction. Median age and weight at primary repair were 4.4 months and 5 Kg respectively. Down syndrome (DS) was diagnosed in 78.6%.

Results: In this population-based retrospective study, operative mortality at repair was 12.9% (95% CI 7.5, 18.3%). Significant postoperative complications Relative hypoplasia of left atrioventricular valve (LAVV) and/ or left ventricle showed to be independent significant risk factors of operative mortality in Multivariate Cox's model (p<0.01). Actuarial estimate of survival at 6 months and 15.5 years following definitive repair after discharge was 99.1% and 98%, respectively. Freedom from reoperation at 15.5 years after definitive operation was 93.5% (95 % CI 89.4, 97.6%). Most reoperations were related to LAVV regurgitation. In a multivariate Cox's model with LAVV dysplasia (2/8=25%) and hypoplasia (2/7=28.6%), patients with such valves abnormalies had less freedom from reoperation (p<0.001).

Conclusions: Left heart obstructive lesion was shown to be independent risk factor for CAVSD surgical outcomes. Therefore, detailed evaluation for such lesions in CAVSD patients should be performed peri-operatively to reduce the impact on operative mortality and LAAV reoperation.