Suzuki Takaaki, Bove Edward L, Devaney Eric J, Ishizaka Toru, Goldberg Caren S, Hirsch Jennifer C, Ohye Richard G
Section of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Ann Thorac Surg. 2008 Aug;86(2):596-602. doi: 10.1016/j.athoracsur.2008.02.032.
Early surgical intervention for complete atrioventricular septal defect (AVSD) has contributed to a decline in postoperative mortality.
We retrospectively evaluated outcomes in 116 complete AVSD patients undergoing definitive repair from February 1997 through October 2002. Patients with an unbalanced AVSD not suitable for biventricular repair, tetralogy of Fallot, or double-outlet right ventricle were excluded.
Median age at operation was 4.8 months (range, 9 days to 5.4 years); weight was 4.8 kg (range, 2.1 to 23 kg). Follow-up was 93% complete (mean, 27 months; range, 1 to 73 months). Early definitive repairs were performed in 98% (110 of 112) of patients initially presenting to our institution. Ninety-two patients (79%) underwent repair before 6 months of age, including 25 (22%) before 3 months. Actuarial survival at 1, 3, and 5 years was 98%, 95%, and 95%, respectively. Seventy-five patients (68%) had trivial to mild left AV valve regurgitation at discharge; moderate or severe left AV valve stenosis developed in 3 (3%). Actuarial freedom from reoperation for left AV valve dysfunction at 1, 3, and 5 years was 94%, 89%, and 89%, respectively. Actuarial freedom from reoperation for left ventricular outflow tract obstruction at 1, 3, and 5 years was 100%, 93%, and 90%, respectively.
Definitive repair for complete AVSD can be performed in early infancy with excellent results. The two-patch technique is a safe and reproducible surgical method that can achieve low mortality and good midterm outcomes even in very young infants.
完全性房室间隔缺损（AVSD）的早期外科干预使术后死亡率有所下降。
我们回顾性评估了1997年2月至2002年10月期间接受根治性修复的116例完全性AVSD患者的治疗结果。排除不适合双心室修复的不平衡AVSD、法洛四联症或右心室双出口患者。
手术时的中位年龄为4.8个月（范围为9天至5.4岁）；体重为4.8千克（范围为2.1至23千克）。随访完成率为93%（平均27个月；范围为1至73个月）。最初到我们机构就诊的患者中，98%（112例中的110例）接受了早期根治性修复。92例患者（79%）在6个月龄前接受了修复，其中25例（22%）在3个月龄前接受了修复。1年、3年和5年的精算生存率分别为98%、95%和95%。75例患者（68%）出院时存在轻度至中度左房室瓣反流；3例（3%）发生中度或重度左房室瓣狭窄。1年、3年和5年因左房室瓣功能障碍再次手术的精算自由度分别为94%、89%和89%。1年、3年和5年因左心室流出道梗阻再次手术的精算自由度分别为100%、93%和90%。
完全性AVSD的根治性修复可在婴儿早期进行，效果良好。双补片技术是一种安全且可重复的手术方法，即使对于非常小的婴儿也能实现低死亡率和良好的中期结果。
