DOI: 10.1177/21501351261497312 ISSN: 2150-1351

Risk Factors for Reoperation and Outcomes Following Repair of Atrioventricular Septal Defects

Yan Le Ho, Chee Chin Hew, Azhari Yaakub, Joyce Dharshini Sirisani, Nurul Fazira Basran, Sivakumar Sivalingam
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Introduction

Reoperations following atrioventricular septal defect (AVSD) repair remain an important cause of late morbidity. This study aimed to evaluate long-term survival and identify risk factors associated with reoperation following AVSD repair.

Methods

A total of 395 patients underwent definitive AVSD repair between January 2010 and December 2021. The primary outcome was freedom from reoperation and identification of predictors of reoperation following index repair. Secondary outcomes included actuarial long-term survival and outcomes following reoperation.

Results

The median age at repair was 1.3(IQR 0.7-6.2) years. Complete AVSD repair accounted for 64.0% (253/395) of cases, while transitional and partial AVSD comprised 19.5% (77/395) and 16.5% (65/395), respectively. Freedom from reoperation was 95.8%, 92.9% and 86.8% at 1, 5 and 10 years, respectively. Twenty-eight of 395 patients(7.1%) underwent reoperation, including left atrioventricular valve (LAVV) repair in 14/28 (50.0%), LAVV replacement in 4/28 (14.3%), right atrioventricular valve (RAVV) repair in 6/28 (21.4%) and left ventricular outflow tract obstruction (LVOTO) resection in 5/28 (17.9%). Independent predictors of LAVV reoperation were age <3 months at initial repair (OR 4.03, 95% CI: 1.55-10.51, P  = .004), double-orifice LAVV repair (OR 6.85, 95% CI: 2.59-18.12, P  < .001) and residual moderate or greater LAVV regurgitation at discharge (OR 8.20, 95% CI: 3.59-21.76, P  < .001). No significant predictors were identified for RAVV or LVOTO reoperation. Actuarial survival at 1, 5 and 10 years was 98.6%, 97.2% and 95.2%, respectively. No early or late mortality occurred among patients undergoing reoperation.

Conclusion

AVSD repair provides excellent long-term survival and low reoperation rates. Residual moderate LAVV regurgitation at discharge is the strongest predictor of reoperation. Durable cleft repair remains critical for long-term valve function. Most patients requiring LAVV reoperation are amenable to re-repair.

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