Short and long term outcomes of repaired complete atrioventricular septal defects: risk factor analysis

ABSTRACT

To study rates of survival and incidence of reoperation of complete atrioventricular septal defects [CAVSD] repair in Kuwait and to determine the risk factors affecting surgical outcome. Retrospective study. Chest Diseases Hospital, Kuwait. One hundred and forty consecutive patients during the 16-year period between January 1992 and December 2007. Surgical correction for CAVSD. Short and long-term surgical outcomes of repaired CAVSD; demographic, cardiac and surgical risk factors that influence the postoperative mortality and morbidity. Median age and weight at primary repair were 4.4 months and 5 kg respectively. Down syndrome was diagnosed in 78.6% of the patients. The operative mortality was 12.9% [95% CI 7.5, 18.3]. Significant postoperative complications, relative hypoplasia of left atrioventricular valve [LAVV] and / or left ventricle were shown to be independent risk factors of operative mortality in multivariate Cox's model [p < 0.01]. Actuarial estimate of survival at six months and 15.5 years following definitive repair after discharge was 99.1% and 98%, respectively. Freedom from reoperation at 16.5 years after definitive operation was 93.5% [95% CI 89.4,97.6]; most reoperations were related to LAVV regurgitation. In the multivariate model with LAVV dysplasia [2/8 = 25%] and hypoplasia [2/7 = 28.6%], patients with such valve abnormalities had less freedom from reoperation [p < 0.001]. Left heart obstructive lesion was shown to be an independent risk factor for CAVSD surgical outcomes. Detailed evaluation for such lesions should be performed peri-operatively to reduce the impact on operative mortality and LAVV reoperation