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The Journal of Thoracic and Cardiovascular Surgery, Vol 90, 711-728, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
LB McGrath, JW Kirklin, EH Blackstone, AD Pacifico, JK Kirklin and LM Bargeron Jr
The 1 month, 1 year, and 10 year actuarial survival rates after operation
among 99 consecutive patients with discordant atrioventricular connection
who underwent intracardiac repair are 86%, 75%, and 68%, respectively. The
hazard function of death declines rapidly after operation to reach a low
level 6 months postoperatively, and it becomes indistinguishable from that
of a matched general population by 4 years. Risk factors for premature
death include double- outlet right ventricle, complete heart block
preoperatively or developing perioperatively, very young or older (greater
than 25 years) age, a high hematocrit value, and earlier date of operation.
The last indicates improvement in results in recent years. Eleven (11%) of
99 patients had complete heart block preoperatively, and 23 (26% of 88)
developed it perioperatively. Patients with discordant ventriculoarterial
connection (i.e., corrected transposition) had a lesser probability of
developing heart block after repair than did those with other
ventriculoarterial connections. Seventeen (17%) patients required tricuspid
(pulmonary venous) valve replacement or repair at the original intracardiac
operation, and eight additional patients developed important incompetence
after repair. Among the risk factors for incompetence was an Ebstein-like
anomaly of the tricuspid valve. Reoperations (three) for conduit
obstruction have been no more common than in patients with concordant
atrioventricular connection. Fifty-seven (81%) of 70 surviving patients are
in New York Heart Association Class I and 12 (17%) in Class II. This, and
the single- phase hazard function, indicate that the overall results of
cardiac repair in patients with atrioventricular discordant connection
could become excellent if the early risks were overcome.
ARTICLES
Death and other events after cardiac repair in discordant atrioventricular connection
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