Improved results after repair of complete atrioventricular septal defect.

Background: This study evaluates the historical impact on the outcomes of early primary repair of complete atrioventricular septal defect (AVSD) at our institute.

Methods: Since 1976, a total of 185 children with complete AVSD have been referred to our unit. Prior to 1990, 78 children received conservative therapy, and selected 51 patients underwent surgical repair (group 1). After 1990, all referred children underwent surgical repair (n = 56; group 2). Pre- and postoperative parameters were analyzed and compared among the groups.

Results: Age at operation was 15.4 +/- 20.4 versus 9.9 +/- 18.0 months in group 1 and group 2, respectively. Association with Down syndrome (53% vs. 82%; p < 0.01) and with patent ductus arteriosus (16 vs. 34%; p < 0.05) was less frequent in group 1. No difference was seen regarding preoperative pulmonary vascular resistance index (RPI). Actuarial survival at 15 years has improved in group 2 (69.3 +/- 6.7 vs. 90.8 +/- 3.9%; p < 0.05). Freedom from reoperation of the left atrioventricular valve at 15 years was not significantly different (78.8 +/- 6.8 vs. 90.6 +/- 4.7%; p = 0.23). Risk factor analysis identified an RPI >6.0 WU/m(2) as a risk for early death.

Conclusion: By operating on the patients with complete AVSD earlier and not excluding patients with Down syndrome, recent results had definitely improved over the last decades. Despite this positive result, a high RPI exceeding 6 WU/m(2) still remains a risk factor for early mortality independent of early primary repair.