Surgical Repair of Complete Atrioventricular Canal: Analysis of Early and Late Results

Abstract

In 1981 the two-patch, three-leaflet concept for correction of common atrioventricular canal (AVC) was introduced in our institution. To date 82 consecutive patients in three different age groups have been operated upon.

Group 1, under 12 months: 29 patients (35.4%), mean weight 5.1 kg (2.9–7.6 kg); group 2, 12–24 months: 25 patients (30.5%), mean weight 7.7 kg (5.2–11.7 kg); group 3, over 24 months: 28 patients (34.1%), mean weight 14.5 kg (7.5–21.7 kg). There were 46 males and 36 females; 44 (53.6%) had Down’s syndrome.

There were 56 associated cardiac anomalies present at correction and included patent ductus arteriosus (21), secundum atrial septal defect (17), multiple ventricular septal defects (7), tetralogy of Fallot (3), double-outlet right ventricle with pulmonary stenosis (1), pulmonary stenosis (1), double orifice mitral valve (2), subaortic stenosis (2), and other more complex anomalies (2).

The preoperative mean right ventricular-left ventricular (RV/LV) pressure ratio measured in the operation room was in the three groups, respectively: 1. 0.90, 2. 0.72, 3. 0.68. After correction it was 1. 0.43, 2. 0.40, 3. 0.43. Eleven patients (13.4%) required reoperation for left AV valve incompetence 2 days-26 months postoperatively; in four replacement of the valve was unavoidable.

There was a significant correlation between the mean preoperative RV/LV pressure ratio and the outcome of the operation: in the five early (6.1%) and the four late deaths (overall mortality 10.9%) this ratio was 0.93 (70%; CL: 0.82–1.04) where in the survivors it was 0.66 (70% CL: 0.57–0.75).