The following is a summary of the “Modified single-patch repair for atrioventricular septal defects results in good functional outcomes in the absence of deep ventricular septal defects,” published in the February 2023 issue of Thoracic and cardiovascular surgery by Kobayashi, et al.

They analyzed the effect on left atrioventricular valve (LAVV) competence of 2-patch repair (TP) and modified single-patch repair (MSP) for full atrioventricular septal defects. Factors that increase the likelihood of undesirable functional outcomes were also found. From 1998 to 2020, 118 individuals with full atrioventricular septal defects with intracardiac repair were included in retrospective research (MSP: 69; TP: 49). The average time spent following up with participants was 10.4 years. The Kaplan-Meier approach was utilized to calculate the functional result of independence from moderate or greater LAVV regurgitation (LAVVR).

Hospital deaths accounted for 1.7% of all deaths (2/118), whereas deaths outside of hospitals accounted for 0.8% (1/118). Only eight patients (four MSP and four TP) needed additional surgery because of LAVV; no additional surgery was necessary because of problems with the left ventricular outflow tract. The receiver operating characteristic curve analysis showed that the ventricular septal defect (VSD) depth was substantially related to moderate or larger postoperative LAVVR in the MSP group without LAVV abnormality, with the optimum cutoff at 10.9 mm. 

The MSP-deep VSD (VSD depth >11 mm) group performed the worst in LAVV competency when compared to the other four groups (P =.002). A multivariate study revealed <4.0 kg, LAVV anomaly, and preoperative LAVVR of moderate or more severity (compared to postoperative LAVVR of mild or greater severity), but not MSP were all independent risk factors for postoperative LAVVR of moderate or greater severity.

The persistence of postoperative LAVVR is a barrier to progress in functional recovery. Until deep VSD is available, MSP offers comparable LAVV capability to TP. Anatomical variants, and notably VSD depth, should guide the choice of surgical strategy.

Source: sciencedirect.com/science/article/abs/pii/S0022522322008509