Intraoperative predictors of left atrioventricular valve reoperation after repair of complete atrioventricular septal defect.

OBJECTIVE

Although outcomes of repair of complete atrioventricular septal defect have improved in recent years, the burden of reoperation on the left atrioventricular valve (LAVV) remains high. We investigated predictors of LAVV reoperation on the intraoperative echocardiogram that may help guide surgical decision making.

METHODS

All patients who underwent repair of complete atrioventricular septal defect at the Royal Children's Hospital from 2010 to 2020 were included in the study. Intraoperative postbypass echocardiograms were individually reviewed. Long-term data were obtained from review of medical records.

RESULTS

Of 134 patients underwent repair of atrioventricular septal defect, early mortality was 1.5% (2 out of 134). After first bypass run, 20.1% (27 out of 134) had moderate or greater residual LAVV regurgitation (LAVVR). A second bypass run to re-repair the LAVV was performed in 8.2% (11 out of 134), after which the mean grade of LAVVR significantly improved from 2.2 to 1.3 (P = .004). Freedom from LAVV reoperation at 10 years was 89.6% in those with no LAVVR, 86.1% in those with mild LAVVR, compared with 61.2% in those with moderate LAVVR (P = .002). Freedom from reoperation at 10 years was 92.7% in patients with no significant LAVVR, 84.2% in those with central LAVV compared with 65.4% in those with eccentric LAVVR (P = .001).

CONCLUSIONS

Moderate or greater LAVVR and an eccentric jet of LAVVR on the intraoperative postbypass echocardiogram predict need for reoperation. A second bypass run to re-repair was associated with an improvement in LAVVR. These results should help guide surgeons when deciding on the need for a second bypass run to re-repair the LAVV.