Results of definitive repair of complete atrioventricular septal defect in neonates and infants.

BACKGROUND: Early surgical intervention for complete atrioventricular septal defect (AVSD) has contributed to a decline in postoperative mortality.

METHODS: We retrospectively evaluated outcomes in 116 complete AVSD patients undergoing definitive repair from February 1997 through October 2002. Patients with an unbalanced AVSD not suitable for biventricular repair, tetralogy of Fallot, or double-outlet right ventricle were excluded.

RESULTS: Median age at operation was 4.8 months (range, 9 days to 5.4 years); weight was 4.8 kg (range, 2.1 to 23 kg). Follow-up was 93% complete (mean, 27 months; range, 1 to 73 months). Early definitive repairs were performed in 98% (110 of 112) of patients initially presenting to our institution. Ninety-two patients (79%) underwent repair before 6 months of age, including 25 (22%) before 3 months. Actuarial survival at 1, 3, and 5 years was 98%, 95%, and 95%, respectively. Seventy-five patients (68%) had trivial to mild left AV valve regurgitation at discharge; moderate or severe left AV valve stenosis developed in 3 (3%). Actuarial freedom from reoperation for left AV valve dysfunction at 1, 3, and 5 years was 94%, 89%, and 89%, respectively. Actuarial freedom from reoperation for left ventricular outflow tract obstruction at 1, 3, and 5 years was 100%, 93%, and 90%, respectively.

CONCLUSIONS: Definitive repair for complete AVSD can be performed in early infancy with excellent results. The two-patch technique is a safe and reproducible surgical method that can achieve low mortality and good midterm outcomes even in very young infants.