What is the best technique for repair of complete atrioventricular canal?

Surgical management of pediatric patients with the diagnosis of complete atrioventricular canal (CAVC) is accomplished by using one of three procedures: (1) the classic single-patch, (2) two-patch, or (3) modified single-patch technique. Of these, the modified single-patch is currently the best technique available for repair of CAVC. The goal of this review is to describe our experience with the modified single-patch technique and explain how it evolved into our procedure of choice for repair of CAVC in our pediatric population. We analyzed specific outcomes (operative mortality, late mortality, mitral valve reoperation, and the incidence of heart block) from our center and those of other institutions that used the modified single-patch technique and compared these with the most current results of the classic single-patch and two-patch techniques reported from several other centers. Our analysis showed that while the occurrence of operative and late mortality was comparable in all three techniques, there was clearly a lower incidence of late reoperations for mitral valve insufficiency and a lower rate of heart block in patients who were repaired with the modified single-patch technique. For these reasons and because of its simplicity, we have adopted the modified single-patch technique as our procedure of choice for repair of complete atrioventricular canal in infants and children.