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Single-Stage Surgical Management of Atrioventricular Septal Defects with Coarctation of the Aorta
Surgical options for coarctation of aorta (CoA) with atrioventricular septal defect (AVSD) include single-stage repair vs. staged approach with neonatal CoA repair and delayed AVSD repair. The durability of left atrioventricular valve (LAVV) function after neonatal repair is questioned, and the opti...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9150633/ https://www.ncbi.nlm.nih.gov/pubmed/35637360 http://dx.doi.org/10.1007/s00246-022-02895-z |
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author | Akam-Venkata, Jyothsna Ikemba, Catherine M. Martinez, Joseph Pruszynski, Jessica Heistein, Lisa Pirolli, Timothy J. Forbess, Joseph M. |
author_facet | Akam-Venkata, Jyothsna Ikemba, Catherine M. Martinez, Joseph Pruszynski, Jessica Heistein, Lisa Pirolli, Timothy J. Forbess, Joseph M. |
author_sort | Akam-Venkata, Jyothsna |
collection | PubMed |
description | Surgical options for coarctation of aorta (CoA) with atrioventricular septal defect (AVSD) include single-stage repair vs. staged approach with neonatal CoA repair and delayed AVSD repair. The durability of left atrioventricular valve (LAVV) function after neonatal repair is questioned, and the optimal approach remains controversial. Eighteen CoA-AVSD patients who underwent single-stage repair 2005–2015 by a single surgeon were retrospectively analyzed. Fifteen patients had complete and three had partial AVSD. Birth weight was 3.19 kg (2.17–4.08). Age at surgery was 16 days (6–127). One- and ten-year survival were 80% and 69%. Freedom from reintervention was 60% and 40% at one and ten-year respectively. Reinterventions included relief of left ventricular outflow tract obstruction (LVOTO) (n = 4), repair of cleft LAVV (n = 3), and LAVV and aortic valve replacement (n = 1). Freedom from LAVV reintervention was 85.6% and 66% at 1 and 10 years respectively. There were four deaths: two post-operative and two following hospital discharge. Mortality was due to sepsis in three patients, and heart failure related to LVOTO and LAVV insufficiency in one. At 68-month (0.6–144) follow-up the majority had mild or less LAVV regurgitation, and all had normal LV dimension and systolic function. There was no recurrent arch obstruction. Single-stage surgical repair of CoA-AVSD is feasible and reasonable. Survival and freedom from reintervention in our cohort approximate those outcomes of two-stage repair with durable left AV valve function and no recurrent arch obstruction. These patients are frequently syndromic and demonstrate mortality risk from non-cardiac causes. Consideration of a single-staged approach is warranted for appropriate patients with CoA-AVSD. |
format | Online Article Text |
id | pubmed-9150633 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-91506332022-06-02 Single-Stage Surgical Management of Atrioventricular Septal Defects with Coarctation of the Aorta Akam-Venkata, Jyothsna Ikemba, Catherine M. Martinez, Joseph Pruszynski, Jessica Heistein, Lisa Pirolli, Timothy J. Forbess, Joseph M. Pediatr Cardiol Original Article Surgical options for coarctation of aorta (CoA) with atrioventricular septal defect (AVSD) include single-stage repair vs. staged approach with neonatal CoA repair and delayed AVSD repair. The durability of left atrioventricular valve (LAVV) function after neonatal repair is questioned, and the optimal approach remains controversial. Eighteen CoA-AVSD patients who underwent single-stage repair 2005–2015 by a single surgeon were retrospectively analyzed. Fifteen patients had complete and three had partial AVSD. Birth weight was 3.19 kg (2.17–4.08). Age at surgery was 16 days (6–127). One- and ten-year survival were 80% and 69%. Freedom from reintervention was 60% and 40% at one and ten-year respectively. Reinterventions included relief of left ventricular outflow tract obstruction (LVOTO) (n = 4), repair of cleft LAVV (n = 3), and LAVV and aortic valve replacement (n = 1). Freedom from LAVV reintervention was 85.6% and 66% at 1 and 10 years respectively. There were four deaths: two post-operative and two following hospital discharge. Mortality was due to sepsis in three patients, and heart failure related to LVOTO and LAVV insufficiency in one. At 68-month (0.6–144) follow-up the majority had mild or less LAVV regurgitation, and all had normal LV dimension and systolic function. There was no recurrent arch obstruction. Single-stage surgical repair of CoA-AVSD is feasible and reasonable. Survival and freedom from reintervention in our cohort approximate those outcomes of two-stage repair with durable left AV valve function and no recurrent arch obstruction. These patients are frequently syndromic and demonstrate mortality risk from non-cardiac causes. Consideration of a single-staged approach is warranted for appropriate patients with CoA-AVSD. Springer US 2022-05-30 2022 /pmc/articles/PMC9150633/ /pubmed/35637360 http://dx.doi.org/10.1007/s00246-022-02895-z Text en © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. |
spellingShingle | Original Article Akam-Venkata, Jyothsna Ikemba, Catherine M. Martinez, Joseph Pruszynski, Jessica Heistein, Lisa Pirolli, Timothy J. Forbess, Joseph M. Single-Stage Surgical Management of Atrioventricular Septal Defects with Coarctation of the Aorta |
title | Single-Stage Surgical Management of Atrioventricular Septal Defects with Coarctation of the Aorta |
title_full | Single-Stage Surgical Management of Atrioventricular Septal Defects with Coarctation of the Aorta |
title_fullStr | Single-Stage Surgical Management of Atrioventricular Septal Defects with Coarctation of the Aorta |
title_full_unstemmed | Single-Stage Surgical Management of Atrioventricular Septal Defects with Coarctation of the Aorta |
title_short | Single-Stage Surgical Management of Atrioventricular Septal Defects with Coarctation of the Aorta |
title_sort | single-stage surgical management of atrioventricular septal defects with coarctation of the aorta |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9150633/ https://www.ncbi.nlm.nih.gov/pubmed/35637360 http://dx.doi.org/10.1007/s00246-022-02895-z |
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