American Association of Plastic Surgeons

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Atypical Left Atrioventricular Valve Affected Surgical Outcome In Children With Incomplete And Transitional Atrioventricular Septal Defect
Nakayama Yuki, Shinkawa Takeshi, Matsumura Goki, Hoki Ryougo, Kobayashi Kei, Okugi Satoshi, Ninami Hiroshi.
Tokyo Women’s Medical University, 8-1 kawata-cho, shinzyuku, Tokyo, Japan.

Objective(s):
To evaluate surgical outcome, especially for left atrioventricular valve (AVV) replacement, of children with incomplete and transitional atrioventricular septal defect (AVSD).
Methods:
We retrospectively reviewed 103 children with incomplete or transitional AVSD operated at our institute between 1983 and 2014. Major outcome studied included patient survival and left AVV replacement.
Results:
Mean age at operation was 4.9±4.1 years. Atypical left AVV, including abnormal subvalvular apparatus, was found in 41 patients, and 36 patients had more than moderate preoperative left AVV regurgitation. All but 8 patients had left AVV cleft closure. Additional left AVV annulplasty was performed in 15 patients and valvuloplasty in 5 patients. Three patients required left AVV replacement at the initial operation. There were 3 early deaths and 4 late deaths. During mean follow-up of 24.9 years, patient’s survival was 95.0% and 92.9% at 1 and 20 years. Seventeen patients had more than moderate left AVV regurgitation postoperatively, and sixteen patients required 18 reoperations for left AVV. Among them, seven patients required left AVV replacement, including 1 redo left AVV replacement. Left AVV replacement free survival at 10 years were 69.8% for the 41 children with atypical left AVV and 98.0% for the remainder of cohort (p<0.01, log rank=15.0). Multivariate analysis showed that atypical left AVV was a risk factor for mortality and left AVV replacement (p= 0.012, χ2=7.3).
Conclusions:
The outcome of surgical repair of partial or transitional AVSD was satisfactory. However, the children with atypical left AVV were at higher risk for left AVV replacement.


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