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J Thorac Cardiovasc Surg 1996;112:14-20
© 1996 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

TEN-YEAR EXPERIENCE WITH SURGICAL TREATMENT OF PARTIAL ATRIOVENTRICULAR SEPTAL DEFECT: RISK FACTORS IN THE EARLY POSTOPERATIVE PERIOD

Received for publication July 5, 1995 revisions requested August 17, 1995; revisions received Oct. 28, 1995 Accepted for publication Nov. 10, 1995. Address for reprints: Francine Leca, MD, Department of Cardiovascular Surgery, Hôpital Laennec, 42 rue de Sèvres, 75007 Paris, France.

Abstract

Partial atrioventricular septal defects are electively repaired with good results. However, recent reports suggest that such repair is potentially a high-risk surgical procedure. Our aim was to determine the risk factors of adverse outcome early after surgical treatment of atrioventricular septal defects in our hospital. A retrospective study was done in 100 consecutive patients from 2 months to 50.6 years old (median 3.6 years) who underwent surgical correction between January 1984 and December 1993. An intermediate form of the lesion was noted in 31% of cases. Congestive heart failure occurred in 50% of cases. Preoperative left atrioventricular valve incompetence (moderate to severe) was present in 63% of patients. Severe abnormalities of left subvalvular apparatus were noted in 28% of patients. The cleft of the left atrioventricular valve was closed in 76% of cases. The study was done to determine risk factors associated with hospital mortality (13%), postoperative residual left atrioventricular valve incompetence (23%), and early reoperation (14%) within the first 30 postoperative days. Univariate analysis showed that age at the date of operation and cleft closure were not related to an early adverse outcome. A stepwise logistic regression with variables selected by univariate analysis identified infections and severe abnormalities of left subvalvular apparatus as predictive factors of early death (odds ratios, 28.07 and 6.18, respectively), preoperative left atrioventricular valve regurgitation as a predictive factor of residual postoperative left atrioventricular valve regurgitation (odds ratio, 5.34), and severe abnormalities of left subvalvular apparatus as a predictive factor of early reoperation (odds ratio, 5.27). These results emphasize the importance of the severity of the morphologic features of the left subvalvular apparatus, the occurrence of early postoperative infections, and the presence of residual left atrioventricular valve regurgitation as risk factors in the early period after surgical correction of partial atrioventricular septal defects. (J THORAC CARDIOVASC SURG 1996;112:14-20)

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