Atrioventricular septal defect (AVSD) : A study of 219 patients who underwent surgery for AVSD at Rikshospitalet from 1979 to 1999

Abstract

Background: The present study evaluates 219 consecutive patients that underwent surgical repair for AVSD in a long term follow-up.

Methods: The patients had a surgical correction for AVSD at Rikshospitalet from January 1979 to December 1999. The follow-up was closed in January 2009. AVSD with additional defects and syndromes were included.

Results: Forty-two patients died during the observational period. Early mortality was 12.8% and late mortality was 6.4%. Early mortality declined from 40% to 5.7%. Median age at primary repair declined from 13.5 months to 5.5 months. A total of 133 patients (60.7%) presented with Down syndrome, 78 (35.6%) was without Down syndrome, 8 (3.6%) had other syndromes. Both the mortality rate and the need of reoperation were lower in the patients with Down syndrome. A total of 139 patients (63.5%) had complete AVSD, 33 (15%) partial AVSD, 28 (12.8%) intermediate AVSD, 3 AVSD and Teratology of Fallot, 19 (8.7%) AVSD in addition to another defect. No significant difference among the techniques related to reoperational rate (p=0.367). The cleft closure rate was 80.36% (176 patients), and it was left open in 39 (17.8%). In patients without Down syndrome it was of high significance to close the zone of apposition (p=0.001). Reoperation was necessary in 29 patients (13.25%), MI was an indication in 14 (48.3%).

Conclusions: Repair of AVSD has improved significantly during the last 30 years. Median age at primary repair declined from 13.5 months to 5.5 months. We found no significant difference in the frequency of reoperation with different techniques. Closure of the zone of apposition seems to be of significant importance in non Down patients only.