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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 196-201, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
ER Capouya, H Laks, DC Drinkwater Jr, JM Pearl and E Milgalter
Left atrioventricular valve regurgitation in atrioventricular canal defects
is usually due to malalignment of the edges of the cleft or to annular
dilatation. Intraoperative assessment and correction of left
atrioventricular valve incompetence is critical for successful outcome in
the surgical management of complete atrioventricular canal defects.
Although some have elected not to suture the cleft in the setting of
minimal incompetence, we have found that this often results in significant
left atrioventricular valve insufficiency, necessitating reoperation. From
January 1982 through December 1990, 105 patients with complete
atrioventricular canal underwent definitive repair. Repair was performed
with a single pericardial patch technique in 86 patients (82%).
Intraoperative assessment of left atrioventricular valve competence was
performed in all cases. Ninety-six patients (91%) required suturing of the
cleft and 63 (60%) required annuloplasty to establish satisfactory
competence of the left atrioventricular valve. The overall early mortality
rate was 10.5% (11/105 patients). From 1986 to 1990, the early mortality
rate decreased to 7.7% (6/78 patients). In a mean follow-up of 39 months
(range 1 to 106 months), late survival was 96% (90/94 operative or early
survivors). Reoperation was performed on eleven (11.5%) patients; six
(6.3%) for failure of the atrioventricular valve repair, three for patch
dehiscence, and two for residual ventricular septal defects. These data
demonstrate that routine approximation of the cleft and aggressive use of
left atrioventricular valve annuloplasty is safe and results in an
excellent outcome with a low incidence of reoperation for failure of left
atrioventricular valve repair.
ARTICLES
Management of the left atrioventricular valve in the repair of complete atrioventricular septal defects
Division of Cardiothoracic Surgery, University of California, Los Angeles Medical Center 90024-1741.
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