Objective Partial atrioventricular septal defect (pAVSD) is usually repaired between 2 and 4 years of age with excellent results. Repair during infancy has been associated with poorer outcomes. However, most infants in reported series had heart failure or significant left atrioventricular valve (LAVV) regurgitation. The impact of surgery during infancy on outcomes remains unclear.
Methods All children at three institutions who underwent repair of pAVSD from 1975 to 2015 were included. Infants (aged <1 year) were compared with older children in a propensity score matched analysis. Variables used to generate propensity scores were: failure to thrive, congestive heart failure, preoperative LAVV regurgitation, associated congenital heart disease, sex and the presence of trisomy 21.
Results pAVSD repair was performed on 430 children, 17.4% (75/430) were infants. Infants (mean age 0.5±0.3 years) had higher rates of LAVV regurgitation, heart failure and additional cardiac malformations than older children (mean age 4.7±3.5 years). At 30 years, survival for infants was 82.1% (95% CI 70.1% to 89.6%) compared with 95.7% (95% CI 91.3% to 97.9%) in older children (P<0.001).
Propensity score matching yielded 52 well-matched pairs. Survival at 30 years was 87.9% (95% CI 75.0% to 94.4%) for infants compared with 98.1% (95% CI 87.1% to 99.7%) for older children (P=0.04). There was no significant difference in freedom from reoperation between the groups.
Conclusions Despite matching for risk factors, survival after repair of pAVSD during infancy is lower than that when repair is performed in older children, with no difference in reoperation rates. This suggests that elective repair of pAVSD should be deferred until after infancy.
- congenital heart disease surgery
- atrial septal defect
- congenital heart disease
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Contributors EB was responsible for designing the study, collecting the data, analysing data and writing the manuscript. MD was responsible for data collection, writing the paper and revising the paper. XTY was responsible for data collection, and contributed to writing the manuscript. DJR was responsible for study design, data collection and revision of manuscript. NA was responsible for study design, data collection and revision of manuscript. CPB was responsible for study design and revision of the manuscript. Yd’U was responsible for study design and revision of the manuscript. IEK did the study design, drafting and revision of the manuscript.
Funding This project was supported by the Victoria Government’s Operational Infrastructure Support Program. EB is a recipient of a Reg Worcester Scholarship from the Royal Australasian College of Surgeons. Yd’U is a National Health and Medical Research Council Clinician Practitioner Fellow (1082186).
Competing interests Yd’U is a consultant for Actelion and MSD. CPB serves on the advisory board of Admedus.
Ethics approval Royal Children’s Hospital Melbourne HREC.
Provenance and peer review Not commissioned; externally peer reviewed.