scholarly journals The effect of surgical technique, age, and Trisomy 21 on early outcome of surgical management of complete atrioventricular canal defect

2021 ◽  
pp. 1-5
Author(s):  
Sherief Azzab ◽  
Ahmed Samy ◽  
Hamdy Singab ◽  
Mohamed Zeinah ◽  
Gledisa Musollari ◽  
...  
Keyword(s):  
Early Intervention ◽  
Surgical Technique ◽  
Trisomy 21 ◽  
Surgical Repair ◽  
P Value ◽  
Valve Regurgitation ◽  
Atrioventricular Canal ◽  
Atrioventricular Canal Defect ◽  
Significant Difference ◽  
Complete Atrioventricular

Abstract Background: The optimal timing, surgical technique, and the influence of Trisomy 21 on the outcome of surgical repair of Complete Atrioventricular Canal Defect remains uncertain. We reviewed our experience in the repair of CAVC to identify the influence of these factors on operative outcomes. Methods: A prospective study included 70 patients, who underwent repair of CAVC at our institute between July, 2016 and October, 2019. Primary endpoint was mortality and the secondary endpoint was a degree of left atrioventricular valve regurgitation. Results: No significant difference was noted between patients operated on, at the first 6 months of age versus later, regarding mortality or LAVV regurgitation. Surgical repair by modified single-patch technique showed a significant reduction in bypass time (71.13 ± 13.507 min versus 99.19 ± 27.092 min, p-value = 0.001). Compared to closure of cleft only, posterior annuloplasty used for repair of LAVV resulted in significant reduction in the occurrence of post-operative valve regurgitation during the early period (LAVV 2 + 43 versus 7 %, p-value = 0.03) and at 6 months of follow-up (LAVV 2 + 35.4 versus 0 %, p-value = 0.01), respectively. Conclusions: Early intervention, in the first 6 months in patients with CAVC by surgical repair gives comparable acceptable results to later repair; Trisomy 21 was not found to be a risk factor for early intervention. Repair of common AV valve by cleft closure with posterior LAVV annuloplasty showed better results with a significant decrease in post-operative LAVV regurgitation and early mortality in comparison to the closure of cleft only.

scholarly journals The Effect of Surgical Technique, Age and Trisomy 21 on Early Outcome of Surgical Management of Complete Atrioventricular Canal Defect

2021 ◽  
Author(s):  
Sherief Azzab ◽  
Ahmed Samy ◽  
Hamdy Singab ◽  
Mohamed Zeinah ◽  
Gledisa Musollari ◽  
...  
Keyword(s):  
Early Intervention ◽  
Surgical Technique ◽  
Trisomy 21 ◽  
Surgical Repair ◽  
Early Period ◽  
Optimal Timing ◽  
P Value ◽  
Atrioventricular Canal ◽  
Atrioventricular Canal Defect ◽  
Significant Difference

Abstract Background: The optimal timing, surgical technique and the influence of Trisomy 21 on outcome of surgical repair of Complete Atrio-Ventricular Canal Defect (CAVC) remain uncertain. We reviewed our experience in repair of CAVC to identify the influence of these factors on operative outcome. Methods: A prospective study included 70 patients who underwent repair of CAVC at our institute between July 2016 to October 2019. Primary endpoint was mortality and secondary endpoint was degree of left atrio‐ventricular valve (LAVV) regurgitation.Results: No significant difference noted between patients operated on, at the first 6 months of age versus later, regarding mortality or LAVV regurgitation. Surgical repair by modified single patch technique showed significant reduction in bypass time (71.13 ± 13.507 min vs 99.19 ± 27.092 min, P value =0.001). Comparison to closure of cleft only, posterior annuloplasty used for repair of LAVV resulted in significant reduction in the occurrence of post-operative valve regurgitation during the early period (LAVV 2+ 43 % vs 7 %, P value=0.03) and at 6 months of follow up (LAVV 2+ 35.4 % vs 0 %, P value=0.01) respectively.Conclusion: Early intervention, in the first 6 months in patients with CAVC by surgical repair gives comparable acceptable results to later repair; Trisomy 21 was not found to be a risk factor for early intervention. Repair of common AV valve by cleft closure with posterior LAVV annuloplasty showed better results with significant decrease in postoperative LAVV regurgitation and early mortality in comparison to closure of cleft only.

scholarly journals The effect of Surgical Technique, Age and Trisomy 21 on early outcome of Surgical Management of Complete Atrioventricular Canal Defect

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sherief Azzab ◽  
Ahmed Samy ◽  
Hamdy Singab ◽  
Mohamed EL Ghanam ◽  
Ahmed Tarek
Keyword(s):  
Down Syndrome ◽  
Early Intervention ◽  
Surgical Technique ◽  
Surgical Repair ◽  
P Value ◽  
Atrioventricular Canal ◽  
End Point ◽  
Atrioventricular Canal Defect ◽  
Significant Difference ◽  
Patch Technique

Abstract Background The optimal timing, surgical technique and the influence of Down syndrome on outcome of surgical repair of Complete Atrio-Ventricular Canal Defect (CAVC) remains uncertain. We reviewed our experience in repair of CAVC to identify the influence of these factors on operative outcome. Methods A prospective study included 70 patients who underwent repair of CAVC at Ain Shams university hospitals, academy of cardiothoracic surgery during the period from July 2016 to October 2019. Age at surgery (less than 6 months old versus later), surgical technique used [(modified single patch versus double patch technique), (use of posterior annuloplasty for repair of left AV valve or not)] and association of Down syndrome were evaluated for their impact on the outcome of surgical repair using multivariate analysis. Patients were followed up for 6 months; primary end point was mortality and secondary end point was reappearance of LAVV regurgitation. Results No significant difference between patients operated on, at the first 6 months of age versus later, regarding mortality or LAVV regurgitation. Down patients showed significant difference in the occurrence of postoperative compared to non-Down patients (LAVVR grade 2 + = 8.9% vs 24%, P value =0.005) respectively. Surgical repair by Modified single patch technique showed significant reduction in cross clamp time (mean = 47.6 ± 9.227 min vs 73.55 ± 21.087 min, P value 0.00), shorter bypass time (mean = 71.13 ± 13.507 min vs 99.19 ± 27.092 min, P value =0.00) and shorter duration of ICU stay (mean =3.2 ± 1.657 days vs 5.3 ± 2.761 days, P value=0.01) as compared to double patch technique. Posterior annuloplasty used for repair of LAVV compared to closure of cleft only resulted in significant reduction in the occurrence of post-operative valve regurgitation during the early period (LAVVR 2+ 43% vs 7%, P value=0.03) and at 6 months of follow up. (LAVVR 2+ 35.4% vs 0%, P value=0.01) respectively. Conclusion early intervention, in the first 6 months in patients with CAVC by surgical repair gives comparable acceptable results to later repair, Down syndrome was not found to be a risk factor for early intervention. Modified single patch and double patch techniques for repair, can be used both with comparable results even in large VSD component (8mm and larger), finally, repair of common AV valve by cleft closure with posterior LAV annulplasty showed better results with significant decrease in postoperative LAV regurgitation and early mortality in comparison to closure of cleft only.

Post-operative course of pulmonary artery pressure after complete atrioventricular canal defect repair

2021 ◽  
pp. 1-7
Author(s):  
Marie Emeline Pierre Louis ◽  
Adnan Bhutta ◽  
Adrian Holloway ◽  
Peter Gaskin
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Pulmonary Vascular Resistance ◽  
Pulmonary Artery Pressure ◽  
Trisomy 21 ◽  
Pulmonary Artery Hypertension ◽  
Atrioventricular Canal ◽  
Atrioventricular Canal Defect ◽  
The Right ◽  
Complete Atrioventricular

Abstract Complete atrioventricular canal defect is a CHD associated with intra-cardiac shunting of blood, which can lead to irreversible changes in pulmonary vascular resistance and pulmonary artery hypertension if unrepaired. Patients with Trisomy 21 are at risk for early development of pulmonary artery hypertension if left uncorrected.1,2 Objectives: The purpose of this study is to describe the evolution of pulmonary artery hypertension after repair of complete atrioventricular canal defect and to determine the time to normalisation of pulmonary artery pressure in both patients with and without Trisomy 21. Methods: This is a single centre, retrospective analysis of patients with complete atrioventricular canal defect admitted for surgical repair at the University of Maryland Medical Center from 2005 to 2015. T-test or Mann–Whitney test and Chi-Square or Fisher’s exact tests were used to compare the two groups (patients with Trisomy 21 and those without). Repeated measures of analysis of variance and serial measurement analysis were performed. Results: Twenty-nine patients meeting the inclusion criteria underwent repair of complete atrioventricular defects during the study period. The right ventricular pressure estimate remained elevated over time and did not show a significant difference between the two groups. Right ventricular to systolic blood pressure ratios for all patients remained > 0.5 over the time periods assessed. Conclusions: Our study suggests that in patients with complete atrioventricular canal defects, the right ventricular pressure remains elevated and does not normalise on echocardiograms performed up to one year after surgery, suggesting a sustained elevation in pulmonary vascular resistance.

scholarly journals Outcomes of surgical repair of complete atrioventricular canal defect in patients younger than 2 years of age

2019 ◽  
Vol 39 (6) ◽  
pp. 422-425
Author(s):  
Mohannad Ali Dawary ◽  
Faisal Dkhalallah Alshamdin ◽  
Louai Hassan Alkhalaf ◽  
Ahmed Othman Alkhamis ◽  
Fareed Ahmed Khouqeer
Keyword(s):  
Surgical Repair ◽  
Atrioventricular Canal ◽  
Atrioventricular Canal Defect ◽  
Complete Atrioventricular

Correction of complete atrioventricular canal defect

1966 ◽  
Vol 18 (5) ◽  
pp. 769-776 ◽  
Author(s):  
Norman B. Thomson ◽  
Faustino N. Niguidula ◽  
Arno Hohn
Keyword(s):  
Atrioventricular Canal ◽  
Atrioventricular Canal Defect ◽  
Complete Atrioventricular

Abstract 4568: Surgical Management of Complete Atrioventricular Septal Defect: Associations with Surgical Technique, Age and Trisomy 21

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Andrew M Atz ◽  
John Hawkins ◽  
Minmin Lu ◽  
Meryl Cohen ◽  
James Jaggers ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Trisomy 21 ◽  
Septal Defect ◽  
Primary Repair ◽  
Atrioventricular Septal Defect ◽  
Icu Stay ◽  
Complete Atrioventricular Septal Defect ◽  
Age At Surgery ◽  
The Impact ◽  
Complete Atrioventricular

Background: Surgical strategies vary for repair of complete atrioventricular septal defect (AVSD). The impact of age, surgical technique and trisomy 21 on contemporary outcomes is poorly defined. Methods: From 6/04 to 2/06, 124 children with primary repair of complete AVSD were studied in a Pediatric Heart Network sponsored observational study. Demographic, procedural, and outcome data were obtained within 28 days of surgery and 6 months later. Results: Median age at repair was 115 days (9 – 396 days). Type of surgical repair was single patch (19%), double patch (71%), and single ASD patch with primary VSD closure (10%). Repair types varied significantly across centers (p=0.002) but there were no differences noted in residual atrial or ventricular septal defects or degree of mitral regurgitation (MR) by repair type within 28 days. Median intensive care unit (ICU) stay was 4 days, length of ventilation 2 days, total hospital stay 7 days; there were no differences by presence of trisomy 21(80% of cohort). A patch margin VSD was detected by echo within 28 days in 43% and at 6 months in 14% (p<0.05). A VSD > 3mm was seen in 6% at discharge and 1% at 6 months. At least moderate MR was present in 26% early and 22% at 6 months. Hospital mortality was 3/124 (2.4%); one within 30 days (0.8%). Overall survival at 6 months was 96% (119/124). Pleural effusion was the most common reported postoperative complication (20%). Earlier age at surgery was associated with longer time on ventilator (p=0.02), longer ICU stay (p=0.03) and use of circulatory arrest (p=0.01). Older age was associated with longer duration of aortic cross clamp time (p=0.05). Age at repair was not associated with residual abnormalities including residual VSD and moderate or greater MR at 6 months. . Conclusions: Contemporary outcomes following repair of complete AVSD are excellent regardless of repair type or presence of trisomy 21. Although a residual VSD may be detected by echo in 43%, most are trivial and resolve by 6 months. Earlier age at surgery is associated with increased resource utilization but has no influence on incidence of residual VSD or significant MR.

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