Real-world research perspective: Evaluation of early follow-up outcomes in patients with partial and transitional atrioventricular septal defects_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YAO Zeyang ^1,2 , XIE Wen ^1,2 , CHEN Zewen ² , ZENG Xiaodong ² , XU Xiaowei ² , WEN Shusheng ² , LIU Tao ³ , XU Gang ² ,  ZHUANG Jian ^1,2

1. School of Medicine, South China University of Technology, Guangzhou, 510080, P. R. China;
2. Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Institute of Cardiovascular Disease, Guangzhou, 510080, P. R. China;
3. Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, East Providence, 02912, USA;

Corresponding author：

ZHUANG Jian, Email: zhuangjian5413@163.com

Keywords：

Partial; transitional; atrioventricular septal defect; real-world study

DOI：

10.7507/1007-4848.202011017

Video：

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Objective To study the clinical characteristics of patients with partial and transitional atrioventricular septal defects (P/TAVSDs) in our hospital, and to evaluate the early follow-up outcomes from a real-world research perspective.Methods The clinical data of all patients diagnosed with P/TAVSDs from January 1, 2018 to July 12, 2020, in our hospital were collected, and all patients' examination results were used as the real-world follow-up data, univariable Cox risk proportional model was used to analyze the outcomes. A total of 93 patients were finally included in the analysis, 72 with partial and 21 with transitional AVSD. There were 38 males and 55 females at age of 182.0 months (20.0 d to 779.5 months).Results Univariable Cox proportional risk model suggested that at least one cardiac malformation (HR=15.00, 95%CI 3.00 to 75.00, P=0.001), preoperative moderate or greater mitral regurgitation (HR=6.60, 95%CI 1.70 to 26.00, P=0.007), and preoperative moderate or greater tricuspid regurgitation (HR=13.00, 95%CI 3.10 to 51.00, P<0.0001) were risk factors for moderate or greater postoperative atrioventricular valve regurgitation.Conclusion Children with coarctation of the aorta or partial pulmonary vein connection, moderate or greater preoperative mitral regurgitation, and moderate or greater preoperative tricuspid regurgitation need to be alerted to the risk of moderate or greater postoperative atrioventricular valve regurgitation. Real-world data, with relaxed statistical P values and combined expertise, can suggest clinical conclusions that are close to those of high-quality retrospective studies.

Citation： YAO Zeyang, XIE Wen, CHEN Zewen, ZENG Xiaodong, XU Xiaowei, WEN Shusheng, LIU Tao, XU Gang, ZHUANG Jian. Real-world research perspective: Evaluation of early follow-up outcomes in patients with partial and transitional atrioventricular septal defects. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(4): 457-462. doi: 10.7507/1007-4848.202011017 Copy

1.	Jacobs JP, Burke RP, Quintessenza JA, et al. Congenital Heart Surgery Nomenclature and Database Project: Atrioventricular canal defect. Ann Thorac Surg, 2000, 69(4 Suppl): S36-S43.
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.	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.
4.	Boening A, Scheewe J, Heine K, et al. Long-term results after surgical correction of atrioventricular septal defects. Eur J Cardiothorac Surg, 2002, 22(2): 167-173.
5.	El-Najdawi EK, Driscoll DJ, Puga FJ, et al. Operation for partial atrioventricular septal defect: A forty-year review. J Thorac Cardiovasc Surg, 2000, 119(5): 880-889.
6.	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.
7.	Tishler B, Gauvreau K, Colan SD, et al. Technical performance score predicts partial/transitional atrioventricular septal defect outcomes. Ann Thorac Surg, 2018, 105(5): 1461-1468.
8.	Chang CI, Becker AE. Surgical anatomy of left ventricular outflow tract obstruction in complete atrioventricular septal defect. A concept for operative repair. J Thorac Cardiovasc Surg, 1987, 94(6): 897-903.
9.	Shiokawa Y, Becker AE. The left ventricular outflow tract in atrioventricular septal defect revisited: Surgical considerations regarding preservation of aortic valve integrity in the perspective of anatomic observations. J Thorac Cardiovasc Surg, 1997, 114(4): 586-593.
10.	Stulak JM, Burkhart HM, Dearani JA, et al. Reoperations after repair of partial atrioventricular septal defect: A 45-year single-center experience. Ann Thorac Surg, 2010, 89(5): 1352-1359.
11.	Gaudino M, Kappetein AP, Di Franco A, et al. Randomized trials in cardiac surgery: JACC review topic of the week. J Am Coll Cardiol, 2020, 75(13): 1593-1604.
12.	Robson C, Mccartan K, Chief editor. Real World Research. New Jersey: John Wiley & Sons, 2016. 32-39.
13.	Tackett SM, Calcaterra D, Magee G, et al. Real-world outcomes of hemostatic matrices in cardiac surgery. J Cardiothorac Vasc Anesth, 2014, 28(6): 1558-1565.
14.	Brezinov OP, Klempfner R, Zekry SB, et al. Prognostic value of ejection fraction in patients admitted with acute coronary syndrome: A real world study. Medicine, 2017, 96(9): e6226.
15.	Liu Y, Chen S, Zühlke L, et al. Global birth prevalence of congenital heart defects 1970-2017: Updated systematic review and meta-analysis of 260 studies. Int J Epidemiol, 2019, 48(2): 455-463.

1. Jacobs JP, Burke RP, Quintessenza JA, et al. Congenital Heart Surgery Nomenclature and Database Project: Atrioventricular canal defect. Ann Thorac Surg, 2000, 69(4 Suppl): S36-S43.
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. 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.
4. Boening A, Scheewe J, Heine K, et al. Long-term results after surgical correction of atrioventricular septal defects. Eur J Cardiothorac Surg, 2002, 22(2): 167-173.
5. El-Najdawi EK, Driscoll DJ, Puga FJ, et al. Operation for partial atrioventricular septal defect: A forty-year review. J Thorac Cardiovasc Surg, 2000, 119(5): 880-889.
6. 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.
7. Tishler B, Gauvreau K, Colan SD, et al. Technical performance score predicts partial/transitional atrioventricular septal defect outcomes. Ann Thorac Surg, 2018, 105(5): 1461-1468.
8. Chang CI, Becker AE. Surgical anatomy of left ventricular outflow tract obstruction in complete atrioventricular septal defect. A concept for operative repair. J Thorac Cardiovasc Surg, 1987, 94(6): 897-903.
9. Shiokawa Y, Becker AE. The left ventricular outflow tract in atrioventricular septal defect revisited: Surgical considerations regarding preservation of aortic valve integrity in the perspective of anatomic observations. J Thorac Cardiovasc Surg, 1997, 114(4): 586-593.
10. Stulak JM, Burkhart HM, Dearani JA, et al. Reoperations after repair of partial atrioventricular septal defect: A 45-year single-center experience. Ann Thorac Surg, 2010, 89(5): 1352-1359.
11. Gaudino M, Kappetein AP, Di Franco A, et al. Randomized trials in cardiac surgery: JACC review topic of the week. J Am Coll Cardiol, 2020, 75(13): 1593-1604.
12. Robson C, Mccartan K, Chief editor. Real World Research. New Jersey: John Wiley & Sons, 2016. 32-39.
13. Tackett SM, Calcaterra D, Magee G, et al. Real-world outcomes of hemostatic matrices in cardiac surgery. J Cardiothorac Vasc Anesth, 2014, 28(6): 1558-1565.
14. Brezinov OP, Klempfner R, Zekry SB, et al. Prognostic value of ejection fraction in patients admitted with acute coronary syndrome: A real world study. Medicine, 2017, 96(9): e6226.
15. Liu Y, Chen S, Zühlke L, et al. Global birth prevalence of congenital heart defects 1970-2017: Updated systematic review and meta-analysis of 260 studies. Int J Epidemiol, 2019, 48(2): 455-463.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Real-world research perspective: Evaluation of early follow-up outcomes in patients with partial and transitional atrioventricular septal defects

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