Left Atrioventricular Valve Regurgitation After Atrioventricular Septal Defect Repair

Arif Selcuk, Division of Cardiac Surgery, Children´s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
Christopher Spurney, Division of Cardiology, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Mahmut Ozturk, Division of Cardiac Surgery, Children´s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
Mitchell Haverty, Division of Cardiac Surgery, Children´s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
Aybala Tongut, Division of Cardiac Surgery, Children´s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
Manan Desai, Division of Cardiac Surgery, Children´s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
In Hye Park, Division of Cardiac Surgery, Children´s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
Rittal Mehta, Division of Cardiac Surgery, Children´s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
Can Yerebakan, Division of Cardiac Surgery, Children´s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
Yves d'Udekem, Division of Cardiac Surgery, Children´s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington DC, USA. Electronic address: yves.dudekem@childrensnational.org.

Document Type

Journal Article

Publication Date

7-25-2024

Journal

The Annals of thoracic surgery

DOI

10.1016/j.athoracsur.2024.07.014

Abstract

BACKGROUND: It remains unclear whether patients with moderate left atrioventricular valve regurgitation (LAVVR) after surgical repair of complete atrioventricular septal defect (CAVSD) should be observed or undergo reoperation. METHODS: A total of 87 out of 220 patients who underwent CAVSD repair, were diagnosed with moderate LAVVR: 47 during the initial hospital stay and 40 after a median of 7 months (IQR: 2-18 months) after the initial operation. RESULTS: Fifteen of these 87 patients who had moderate LAVVR deceased for an overall mortality of 17%. The regurgitation became severe in 39 patients (45%, 39/87) within a median of 2 months (1-7) leading to 33 reoperations and 10 deaths. In 23 patients (26%, 23/87), regurgitation remained at a moderate level over a median follow-up period of 8 months (1-48). In 25 patients (29%, 25/87) the regurgitation decreased to mild after a median of 9 months (5-19). The only independent risk factor for increased severity of regurgitation and reoperation was the echocardiographic appearance of the jet centered around the cleft rather than central at the time of diagnosis of moderate regurgitation (OR:3.5; 95%CI: 1.5-9.0; p=0.007). CONCLUSIONS: Moderate LAVVR after CAVSD repair is often linked to death and reoperation, but in a quarter of patients, regurgitation remains stable and in a third, it improves. The deterioration usually occurs within the first year after surgery. The initial observation of patients with residual or new moderate regurgitation for up to a year or until further deterioration seems reasonable, as long as the regurgitation is centrally located.

Department

Surgery

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