Few reports of early surgical repair of complete atrioventricular septal defect (AVSD) exist. EACTS database shows relatively late age and significant surgical mortality in the infant undergoing early AVSD repair. Our policy is to repair whenever CHF symptoms occur or elective surgery at 3 months.Between Jan 2006 and Dec 2008, 24 patients with Complete AVSD underwent definitive repair. Median age at surgery was 52(±42) days and median weight was 3.6(±1, 0) Kg, 22 patients were < 2 months, 6 patients were < 2.5 Kg. Four had unbalanced AVSD. All but one patient had Down’s syndrome.
CPB time was 57(±13) min; Aortic crossclamp time was 33(±7) min.
Two pericardial patches were used. Mitral annuloplasty was often achieved with the Ventricular Septal Defect (VSD) patch (70%); cleft closure was performed in 26%. The Sternum was closed in 100%. Median mechanical ventilation time was 24 hrs. ICU stay was a median 5.4(± 5) days. No surgical or late mortality occurred. Two patients with unbalanced AVSD were reoperated for residual VSD. All 24 pts are doing well on follow up (2y), 83% are on no medication. 96% have mild or trivial MI. One patient has moderate mitral incompetence and may need further surgery. In conclusion, early surgery with no mortality and limited morbidity can be achieved even in smaller patients with our simplified surgical technique. Shortened operating times and reduced needs of post operative support are part of our surgical strategy. Early repair reduces preop morbidity and allows earlier normal growth and psychomotor stimulation.