Complete Atrioventricular Canal Defect: Influence of Timing of Repair on Intermediate Outcomes

Background: The optimal timing of repair of complete atrioventricular canal defect (CAVC) remains uncertain. When early repair is indicated due to clinical conditions, patients may be potentially exposed to excess morbidity or mortality. We reviewed our experience with repair of CAVC to determine the influence of age on outcomes. Methods: The study included 48 patients who underwent repair of CAVC at our institution from 2004 to 2014. To assess the association of age at surgery with outcomes, logistic regression models were fit to binary outcomes and linear regression models were fit for continuous outcomes. Age at surgery was dichotomized into early (≤90 days; n = 18) and late repair (>90 days; n = 30). Chi-square and two-sample t tests were used to compare early to late repair with respect to patient characteristics and outcomes. Results: Patient characteristics were similar except for mean weight at surgery (3.9 vs 4.6 kg) and presence of greater than equal to moderate left atrioventricular valve regurgitation (LAVVR; 1 vs 11). When assessed by continuous scale or dichotomized at 90 days, there was no association of age at repair with outcomes including median bypass and clamp times, need for pacemaker implantation, pulmonary hypertension requiring oxygen and/or medication, median length of stay, incidence of greater than equal to moderate LAVVR at discharge, and rate of reoperation for LAVVR. Freedom from greater than equal to moderate LAVVR was similar between the groups at latest follow-up. Conclusion: Contemporary repair of CAVC is associated with low mortality and favorable outcomes. In the presence of clear signs of congestive heart failure, primary repair can be safely accomplished in patients under three months of age.

Duke Scholars

Author Brian Clark Surgery, Cardiovascular and Thoracic Surgery