Early experience in surgical treatment of complete atrioventricular septal defect with patient’s own tissue

  • Prof Piotr Burczynski, Cardiothoracic Department, Childrens' Health Memoral Hospital Warsaw, Poland
  • Dr Krzysztof Mozol, Cardiothoracic Department, Childrens' Health Memoral Hospital Warsaw, Poland
  • Dr Michal Kozlowski, Cardiothoracic Department, Childrens' Health Memoral Hospital Warsaw, Poland
  • Dr Mariusz Birbach, Cardiothoracic Department, Childrens' Health Memoral Hospital Warsaw, Poland
  • Dr Andrzej Kansy, Cardiothoracic Department, Childrens' Health Memoral Hospital Warsaw, Poland
  • Dr Malgorzata Malek, Cardiothoracic Department, Childrens' Health Memoral Hospital Warsaw, Poland
  • Prof Wanda Kawalec, Cardiology Department, Childrens' Health Memoral Hospital Warsaw
  • Prof Bohdan Maruszewski, Cardiothoracic Department, Childrens' Health Memoral Hospital Warsaw

    • Background:
    In current practice, correction of CAVSD can be performed using one of the three techniques: single patch, two patch or modified single patch. We summarize our experience with two patch technique using glutarladehyde-treated autologous pericardial patch for closure of CAVSD.

    Materials and Methods:
    30 children (11 males, 19 females) underwent CAVSD repair using glutaraldehyde-treated autologous pericardium between January 2006 and October 2008. The age and weight at the time of surgery were: 63 – 362 days (median – 179 days), and 3.3 – 8.0 kg (median 5.0 kg). After establishing cardiopulmonary bypass, a strip of pericardium was harvested from the patient, bathed in 0,6% glutharaldehyde solution for between 10 and 12 minutes, and subsequently washed out with 0,9% saline solution. Follow-up time varied from 20 to 773 days (median – 369 days).

    Results:
    There was a 90% 1-year survival, with no 30-day mortality found. Of the two children who died of non-cardiac reasons, one was in critical condition in pre-operative period. Postoperative 2D echocardiograms have shown moderate left AV valve incompetence in 7 (24.1%), and severe in 4 (13.8%). 3 patients required reoperation due to residual shunt (2), and/or severe left AV valve incompetence. One patient required pacemaker.

    Conclusions:
    Glutharaldehyde-treated autologous pericardium is an excellent material for surgical repair of CAVSD. Due to the flexibility and compliance of the pericardium we believe it prevents LVOT obstruction and diminishes AV incompetence. Although our results are promising, further follow-up is required to assess long-term efficacy of this method.