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Surgery of Complete Atrioventricular Septal Defect : Evolution of Results in a Single Center over a period of 50 years

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Title: Surgery of Complete Atrioventricular Septal Defect : Evolution of Results in a Single Center over a period of 50 years
Author(s): Airaksinen, Riku
Contributor: University of Helsinki, Faculty of Medicine
Discipline: Paediatric Surgery
Language: English
Acceptance year: 2016
Background. Operative mortality after complete atrioventricular septal defect (cAVSD) repair has improved vastly. Less improvement has been demonstrated regarding late mortality and reoperation rates. There is evident lack of particularly comprehensive population based studies analyzing history and progress of the ever-changing operative results. Objectives. The purpose of this study was to determine the long-term outcome, atrioventricular valve reoperation rate, and risk factors of mortality and reoperation during the 50-year period of corrective surgery of complete atrioventricular septal defect at single institution. Methods. This is a 5 million population based retrospective study of all cAVSD-operated patients in Finland between 1962-2014, consisting of 388 consecutive patients. Data was collected using Childrens Cardiac Surgical Registry of Children's Hospital at the Helsinki University Hospital, Finland. Mortality data and reoperation rates were analyzed on a decade by decade basis. Results. Since the early era, overall mortality has been 17.4%, out of which 10.9% has been comprised by operative mortality. The operative results have improved significantly through the decades, and eventually the last decade showed no mortality. Total of 23 late deaths occurred, out of which 20 were directly heart related. Half of the late mortality occurred during the first postoperative year. The only significant risk factor for overall mortality was earlier decade of operation (p<0,001). Reoperation rates have not decreased but rather increased over decades (p=0,621) and have been performed mainly during the first year after the primary operation. Actuarial freedom from left side AV valve reoperation at 15 years was 90,9%. Conclusions. There has been outstanding improvement in surgical results through years even though the general operative approach has remained the same. Rates of reoperation have not been declining, but the reoperations are dated to early childhood years. The improvement in results is still ongoing.
Keyword(s): AV Canal Endocardial Cushion Defect Cardiac Malformation Atrioventricular Septal Defect

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