Modified single-patch technique for children with complete atrioventricular septal defect in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Zewen ¹ , LI Xiaohua ¹ ,  WEN Shusheng ¹ , CHEN Jimei ¹ , ZHUANG Jian ¹ , LI Yifan ² , CEN Jianzheng ¹ , XU Gang ¹ , CUI Hujun ¹ , TENG Yun ¹ , ZHANG Yong ¹ , XIE Wen ¹

1. Department of Congenital Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Key Laboratory of South China Structural Heart Diseases, Guangzhou, 510100, P.R.China;
2. Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Key Laboratory of South China Structural Heart Diseases, Guangzhou, 510100, P.R.China;

Corresponding author：

WEN Shusheng, Email: doctorwen@gmail.com

Keywords：

Complete atrioventricular septal defect; children; surgical correction; modified single-patch technique; atrioventricular valve regurgitation

DOI：

10.7507/1007-4848.202004033

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Objective To sum up the experience of the primary modified single-patch (MSP) technique applied in our hospital for children with complete atrioventricular septal defect (CAVSD).Methods The clinical data of 141 children who underwent primary MSP technique for CAVSD between June 2009 and December 2017 were retrospectively analyzed, including 62 males and 79 females with a median age of 6 (3, 11) months and a median weight of 5.8 (4.5, 7.0) kg. According to Rastelli classification, there were 116 patients in type A, 14 in type B and 11 in type C. Among them, 15 patients were diagnosed with Down’s syndrome. Cardiopulmonary bypass time, aortic cross clamp time, atrioventricular valve regurgitation and other clinical data were recorded during and after operation. Results Postoperatively, 17 patients suffered from severe left atrioventricular valve regurgitation (LAVVR) and 6 patients severe right atrioventricular valve regurgitation (RAVVR). In the follow-up period, 5 patients suffered from severe LAVVR and 1 patient severe RAVVR. Left ventricular outflow tract obstruction (LVOTO) appeared in 1 patient during follow-up period and none at the end of follow-up. There were 5 early deaths and 2 late deaths. Twelve patients underwent reoperation with a median interval time of 268 (8, 1 270) days.Conclusion MSP technique is a wise surgical strategy for CAVSD children with good outcomes, improved postoperative mortality and decreased atrioventricular valve regurgitation.

Citation： CHEN Zewen, LI Xiaohua, WEN Shusheng, CHEN Jimei, ZHUANG Jian, LI Yifan, CEN Jianzheng, XU Gang, CUI Hujun, TENG Yun, ZHANG Yong, XIE Wen. Modified single-patch technique for children with complete atrioventricular septal defect in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(4): 435-440. doi: 10.7507/1007-4848.202004033 Copy

1.	Hoohenkerk GJ, Bruggemans EF, Rijlaarsdam M, et al. More than 30 years' experience with surgical correction of atrioventricular septal defects. Ann Thorac Surg, 2010, 90(5): 1554-1561.
2.	Jacobs JP, Jacobs ML, Mavroudis C, et al. Atrioventricular septal defects: Lessons learned about patterns of practice and outcomes from the congenital heart surgery database of the Society of Thoracic Surgeons. World J Pediatr Congenit Heart Surg, 2010, 1(1): 68-77.
3.	Pan G, Song L, Zhou X, et al. Complete atrioventricular septal defect: Comparison of modified single-patch technique with two-patch technique in infants. J Card Surg, 2014, 29(2): 251-255.
4.	Yildirim O, Avsar M, Ozyuksel A, et al. Modified single versus double-patch technique for the repair of complete atrioventricular septal defect. J Card Surg, 2015, 30(7): 595-600.
5.	Ugaki S, Khoo NS, Ross DB, et al. Modified single-patch compared with two-patch repair of complete atrioventricular septal defect. Ann Thorac Surg, 2014, 97(2): 666-671.
6.	Backer CL, Stewart RD, Mavroudis C. What is the best technique for repair of complete atrioventricular canal? Semin Thorac Cardiovasc Surg, 2007, 19(3): 249-257.
7.	Cui H, Nie Z, Ou Y, et al. Early and midterm outcomes of a modified single-patch technique for repairing complete atrioventricular septal defect in children and adults. J Card Surg, 2020, 35(1): 75-82.
8.	Atz AM, Hawkins JA, Lu M, et al. Surgical management of complete atrioventricular septal defect: Associations with surgical technique, age, and trisomy 21. J Thorac Cardiovasc Surg, 2011, 141(6): 1371-1379.
9.	Kobayashi M, Takahashi Y, Ando M. Ideal timing of surgical repair of isolated complete atrioventricular septal defect. Interact Cardiovasc Thorac Surg, 2007, 6(1): 24-26.
10.	Craig B. Atrioventricular septal defect: from fetus to adult. Heart, 2006, 92(12): 1879-1885.
11.	Burstein DS, Gray PE, Griffis HM, et al. Preoperative clinical and echocardiographic factors associated with surgical timing and outcomes in primary repair of common atrioventricular canal defect. Pediatr Cardiol, 2019, 40(5): 1057-1063.
12.	Cui HJ, Zhuang J, Chen JM, et al. Surgical treatment and early-mid follow-up results of complete atrioventricular septal. Zhonghua Wai Ke Za Zhi, 2017, 55(12): 933-937.
13.	Shi G, Chen H, Hong H, et al. Results of one-and-a-half-patch technique for repair of complete atrioventricular septal defect with a large ventricular component. Eur J Cardiothorac Surg, 2015, 47(3): 520-524.
14.	Bakhtiary F, Takacs J, Cho MY, et al. Long-term results after repair of complete atrioventricular septal defect with two-patch technique. Ann Thorac Surg, 2010, 89(4): 1239-1243.
15.	Fong LS, Winlaw DS, Orr Y. Is the modified single-patch repair superior to the double-patch repair of complete atrioventricular septal defects? Interact Cardiovasc Thorac Surg, 2019, 28(3): 427-431.
16.	Wang G, Ma K, Pang K, et al. Modified single repair technique for complete atrioventricular septal defect: A propensity score matching analysis. Pediatr Cardiol, 2020, 41(3): 615-623.
17.	Backer CL, Eltayeb O, Mongé MC, et al. Modified single patch: Are we still worried about subaortic stenosis? Ann Thorac Surg, 2015, 99(5): 1671-1675.
18.	Fong LS, Betts K, Bell D, et al. Complete atrioventricular septal defect repair in Australia: Results over 25 years. J Thorac Cardiovasc Surg, 2020, 159(3): 1014-1025.
19.	Xie O, Brizard CP, d'Udekem Y, et al. Outcomes of repair of complete atrioventricular septal defect in the current era. Eur J Cardiothorac Surg, 2014, 45(4): 610-617.

1. Hoohenkerk GJ, Bruggemans EF, Rijlaarsdam M, et al. More than 30 years' experience with surgical correction of atrioventricular septal defects. Ann Thorac Surg, 2010, 90(5): 1554-1561.
2. Jacobs JP, Jacobs ML, Mavroudis C, et al. Atrioventricular septal defects: Lessons learned about patterns of practice and outcomes from the congenital heart surgery database of the Society of Thoracic Surgeons. World J Pediatr Congenit Heart Surg, 2010, 1(1): 68-77.
3. Pan G, Song L, Zhou X, et al. Complete atrioventricular septal defect: Comparison of modified single-patch technique with two-patch technique in infants. J Card Surg, 2014, 29(2): 251-255.
4. Yildirim O, Avsar M, Ozyuksel A, et al. Modified single versus double-patch technique for the repair of complete atrioventricular septal defect. J Card Surg, 2015, 30(7): 595-600.
5. Ugaki S, Khoo NS, Ross DB, et al. Modified single-patch compared with two-patch repair of complete atrioventricular septal defect. Ann Thorac Surg, 2014, 97(2): 666-671.
6. Backer CL, Stewart RD, Mavroudis C. What is the best technique for repair of complete atrioventricular canal? Semin Thorac Cardiovasc Surg, 2007, 19(3): 249-257.
7. Cui H, Nie Z, Ou Y, et al. Early and midterm outcomes of a modified single-patch technique for repairing complete atrioventricular septal defect in children and adults. J Card Surg, 2020, 35(1): 75-82.
8. Atz AM, Hawkins JA, Lu M, et al. Surgical management of complete atrioventricular septal defect: Associations with surgical technique, age, and trisomy 21. J Thorac Cardiovasc Surg, 2011, 141(6): 1371-1379.
9. Kobayashi M, Takahashi Y, Ando M. Ideal timing of surgical repair of isolated complete atrioventricular septal defect. Interact Cardiovasc Thorac Surg, 2007, 6(1): 24-26.
10. Craig B. Atrioventricular septal defect: from fetus to adult. Heart, 2006, 92(12): 1879-1885.
11. Burstein DS, Gray PE, Griffis HM, et al. Preoperative clinical and echocardiographic factors associated with surgical timing and outcomes in primary repair of common atrioventricular canal defect. Pediatr Cardiol, 2019, 40(5): 1057-1063.
12. Cui HJ, Zhuang J, Chen JM, et al. Surgical treatment and early-mid follow-up results of complete atrioventricular septal. Zhonghua Wai Ke Za Zhi, 2017, 55(12): 933-937.
13. Shi G, Chen H, Hong H, et al. Results of one-and-a-half-patch technique for repair of complete atrioventricular septal defect with a large ventricular component. Eur J Cardiothorac Surg, 2015, 47(3): 520-524.
14. Bakhtiary F, Takacs J, Cho MY, et al. Long-term results after repair of complete atrioventricular septal defect with two-patch technique. Ann Thorac Surg, 2010, 89(4): 1239-1243.
15. Fong LS, Winlaw DS, Orr Y. Is the modified single-patch repair superior to the double-patch repair of complete atrioventricular septal defects? Interact Cardiovasc Thorac Surg, 2019, 28(3): 427-431.
16. Wang G, Ma K, Pang K, et al. Modified single repair technique for complete atrioventricular septal defect: A propensity score matching analysis. Pediatr Cardiol, 2020, 41(3): 615-623.
17. Backer CL, Eltayeb O, Mongé MC, et al. Modified single patch: Are we still worried about subaortic stenosis? Ann Thorac Surg, 2015, 99(5): 1671-1675.
18. Fong LS, Betts K, Bell D, et al. Complete atrioventricular septal defect repair in Australia: Results over 25 years. J Thorac Cardiovasc Surg, 2020, 159(3): 1014-1025.
19. Xie O, Brizard CP, d'Udekem Y, et al. Outcomes of repair of complete atrioventricular septal defect in the current era. Eur J Cardiothorac Surg, 2014, 45(4): 610-617.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Modified single-patch technique for children with complete atrioventricular septal defect in a single center

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