Boston - American Association for Thoracic Surgery

AMERICAN ASSOCIATION FOR THORACIC SURGERY27. Depth of Ventricular Septal Defect and Impact on Reoperation forLeft Ventricular Outflow Obstruction After Repair of CompleteAtrioventricular Septal Defect: Does Double Patch TechniqueDecrease the Incidence of Left Ventricular Outflow Obstruction?Anatomical and Clinical CorrelationAnastasios C. Polimenakos, 1 Shyam K. Sathanandam, 2 Soraia Bharati, 2Vivian Cui, 2 David Roberson, 2 Mary Jane Barth, 2 Chawki El Zein, 2Robert S.D. Higgins, 1* Michel Ilbawi 21. Center for Congenital and Structural Heart Disease/Rush University Medical Center,Chicago, IL, USA; 2. The Heart Institute for Children at Hope Christ Hospital, OakLawn, IL, USAInvited Discussant: Carl L. BackerMONDAYAfternoonOBJECTIVE: In complete atrioventricular septal defect (CAVSD) left ventricularoutflow (LVOT) obstruction is of concern. Modified single patch technique (MSP)has been used as an alternative to double patch technique (DP). Clinical analysis ofCAVSD repairs was conducted. Anatomical comparison between MSP and DP inunoperated specimens was performed and the impact of the depth of ventricularseptal defect on LVOT assessed.METHODS: From September 2002 to August 2008, 77 infants underwent CAVSDrepair. Thirteen had MSP and 64 DP. Seven of 13 had trisomy 21 vs 46 of 64 (p ns).Mean age was 4.6 ± 1.1 months (MSP) vs 4.9 ± 1.3 months (DP) (p ns). LVOT peakgradient (PG) and depth of the ventricular component of the AVSD (dVSD) fromAV valve annulus were measured by echocardiogram and dVSD expressed as aratio to the length of ventricular septum from the apex (D). Sixteen anatomy specimenswere examined. Each had MSP. The repair was, then, taken down followed byDP. Each specimen served as its own control. Measurements of LVOT were taken:1 at the level of the free edge of AV valve anterior leaflet, 3 immediately in the subaorticvalve area, 2 at the mid-distance. A and B indicate DP and MSP respectively.Finally, dVSD and D ratio were measured.RESULTS: Rastelli type A were 47 (10 MSP vs 37 DP), 3 type B (1 MSP vs 2 DP)and 27 type C (2 MSP vs 25 DP). Patients with smaller dVSD (D ratio) preferentiallyhad MSP (0.21 ± 0.07 in MSP vs 0.32 ± 0.07 in DP, p < 0.001). Mean follow-up was36.4 ± 2.3 months. Fifteen patients developed LVOT PG greater than 20 mmHg (4 of13 had MSP, 30.8% vs 11 of 64 had DP, 20.7% – p < 0.05 ). When freedom fromreoperation for LVOT obstruction (LVOT PG greater than 50 mmHG) was analyzed3 of 13 (23%) with MSP and 6 of 64 (9.4%) with DP (p < 0.05) required surgicalintervention. Seven had modified Konno and 2 subaortic resection. In anatomicalcomparison, 1A was 20.67 ± 7.05 mm vs 1B 12.33 ± 4.96 mm (p < 0.001). 2A was12.55 ± 3.36 mm vs 2B 8.72 ± 1.71 mm (p < 0.001). 3A was 8.99 ± 2.29 mm vs 3B 7.65± 1.81 mm (p < 0.001). There was direct correlation between reduction of LVOT atlevel 1 and dVSD (D ratio) when the MSPT was used (p 0.025, Pearson’s r 0.557).* AATS Member117