Buratto Edward, Cheung Michael M H, Ratnaraj Vignesh, Perrier Stephanie, Konstantinov Igor E, Brizard Christian P
Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Cardiology, Royal Children's Hospital, Melbourne, Victoria, Australia.
J Thorac Cardiovasc Surg. 2025 Sep 2. doi: 10.1016/j.jtcvs.2025.08.033.
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.
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.
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).
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.
尽管近年来完全性房室间隔缺损修复的结果有所改善，但左房室瓣（LAVV）再次手术的负担仍然很高。我们研究了术中超声心动图上LAVV再次手术的预测因素，这些因素可能有助于指导手术决策。
纳入2010年至2020年在皇家儿童医院接受完全性房室间隔缺损修复的所有患者。对术中体外循环后的超声心动图进行单独评估。通过查阅病历获得长期数据。
134例接受房室间隔缺损修复的患者中，早期死亡率为1.5%（134例中有2例）。首次体外循环后，20.1%（134例中有27例）存在中度或更严重的LAVV反流（LAVVR）。8.2%（134例中有11例）进行了第二次体外循环以再次修复LAVV，之后LAVVR的平均分级从2.2显著改善至1.3（P = 0.004）。无LAVVR者10年无LAVV再次手术的概率为89.6%，轻度LAVVR者为86.1%，而中度LAVVR者为61.2%（P = 0.002）。无明显LAVVR的患者10年再次手术的概率为92.7%，LAVV中央反流者为84.2%，而偏心性LAVVR者为65.4%（P = 0.001）。
术中体外循环后超声心动图显示中度或更严重的LAVVR以及LAVVR的偏心性反流束提示需要再次手术。第二次体外循环再次修复与LAVVR改善相关。这些结果应有助于指导外科医生决定是否需要第二次体外循环来再次修复LAVV。
