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

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

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.

Abstract 14773: Biventricular Conversion After Fontan Completion: A Preliminary Experience

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ilias P Doulamis ◽  
Supreet P Marathe ◽  
Breanna L Piekarski ◽  
Rebecca S Beroukhim ◽  
Gerald R Marx ◽  
...  
Keyword(s):  
Fontan Circulation ◽  
Exercise Intolerance ◽  
Optimal Timing ◽  
Atrioventricular Canal ◽  
Protein Losing Enteropathy ◽  
Systolic Volume ◽  
Hepatic Congestion ◽  
Atrioventricular Canal Defect ◽  
Fontan Physiology ◽  
Failing Fontan

Hypothesis: Biventricular conversion (BiVC) following takedown of Fontan circulation is feasible and results in improved hemodynamics. Methods: Retrospective analysis of patients who had takedown of Fontan circulation and conversion to BiV circulation at a single center from September 2007 to April 2020. Failing Fontan physiology was defined as Fontan circulation pressure >15 mmHg. Results: There were 23 patients (median age: 10.0 (7.5-13.0) years); 15 (65%) had failing Fontan physiology and 8 (35%) underwent elective takedown of their Fontan circulation. Of the 15 patients with failing Fontan physiology, 4 had exercise intolerance or cyanosis, 3 had hepatic congestion or cirrhosis, 3 had end-organ damage and 1 patient had protein losing enteropathy; the rest 4 patients had no other sign of SVP complications. A subset of patients (n=6) underwent recruitment of the non-dominant ventricle prior to conversion. HLHS (p<0.01) and sub-/aortic stenosis (p<0.01) were more common in these patients. BiVC with or without staged ventricular recruitment led to a significant increase in indexed end-diastolic volume (p<0.01), indexed end-systolic volume (p<0.01) and ventricular mass (p<0.01) of the non-dominant ventricle (14 RV, 9 LV). There were 1 (4%) early and 4 (17%) late deaths. All who underwent elective BiVC survived, while 2-year survival rate for patients with a failing Fontan circulation was 72.7% (95% CI: 37-90%) (Figure 1). The overall, 1-year reintervention free survival was 44.1% (95% CI: 21-65%). Left dominant atrioventricular canal defect (p<0.01) and early year of BiVC (p=0.02) were significant predictors for mortality. Conclusions: BiVC is feasible in patients with failing Fontans, and has promising outcomes after elective takedown of Fontan circulation. A staged approach for ventricular recruitment does not seem inferior to primary BiVC. The optimal timing for BiVC in Fontan patients needs further evaluation.

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

Cyanoacrylate Based Products as Interpositioning Substance versus Reintervention Alone for Urethrocutaneous Fistula Repair after Hypospadias

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H M Abdallah ◽  
A M Tawfeek ◽  
A M W Mohareb
Keyword(s):  
Success Rate ◽  
Surgical Repair ◽  
Fistula Formation ◽  
P Value ◽  
Hypospadias Repair ◽  
Urethrocutaneous Fistula ◽  
Cyanoacrylate Glue ◽  
Recurrent Fistula ◽  
Significant Difference ◽  
Basis Method

Abstract Background urethrocutaneous fistula (UCF) is still the commonest complication after hypospadias repair. Although recent advances in the surgical procedures of hypospadias repair have reduced the rate of urethrocutaneous fistula formation, it remains a real complication of hypospadias and frustrating problem for surgeons. Aim of the Work evaluation of success and failure rates of using cyanoacrylate based productes as an interpositioning substance in surgical repair of fistula after hypospadias in comparison to the classic surgical repair technique. Patients and Methods this is a prospective, randomized-controled study, conducted on 40 patients from the date of the approval of the study. It is comparing two different modalities for repair of urethrocutaneous fistula that has developed after hypospadias repair. Our study was assigned on a randomized basis method according to a 1:1 ratio and patients underwent either multilayered closure using dartos facial flap or using cyanoacrylate glue as an interpositioning layer before suturing of the dartos flap for the closure of the urethrocutaneous fistula. All cases were divided into 2 equal groups, 20 cases each. The cases were distributed randomly into the two groups. Results the success rate was higher for patients using cyanoacrylate glue as a protective interpositioning layer as 16 patients (80%) were successfully repaired and 4 patients (20%) developed a recurrent fistula. However, there was no statistically significant difference between 2 groups p-value was 0.465. Conclusion there was no statistically significant difference in adding cyanoacrylate glue to multilayered closure of urethrocutaneous fistula after hypospadias repair. However, cyanoacrylates showed that they are a favourable additional protective substance and they resulted in a high success rate without adding any surgical complications.

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

2017 ◽  
Vol 8 (3) ◽  
pp. 361-366
Author(s):  
Khushboo N. Parikh ◽  
Nishant C. Shah ◽  
John L. Myers ◽  
Allen R. Kunselman ◽  
Joseph B. Clark
Keyword(s):  
Regression Models ◽  
Pacemaker Implantation ◽  
Patient Characteristics ◽  
Optimal Timing ◽  
Atrioventricular Canal ◽  
Atrioventricular Valve Regurgitation ◽  
Intermediate Outcomes ◽  
Age At Surgery ◽  
Atrioventricular Canal Defect ◽  
Complete Atrioventricular

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.

Surgical Repair of Acute Gracilis Muscle Rupture in the Racing Greyhound

1992 ◽  
Vol 05 (01) ◽  
pp. 18-21 ◽  
Author(s):  
R. Eaton-Wells
Keyword(s):  
Retrospective Study ◽  
Surgical Technique ◽  
Surgical Repair ◽  
Gracilis Muscle ◽  
Back Muscle ◽  
Suture Materials ◽  
Muscle Rupture

A retrospective study of the surgical repair of 27 cases of acute gracilis muscle rupture ("dropped back muscle") in 23 racing greyhounds was conducted.All of the dogs suffered the injury while racing or training. Suture materials and surgical technique are described. The dogs ability to resume racing was assessed.

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