Surgical correction of atrioventricular septal defect

Abstract

This thesis focuses on more than 30 years__ experience of surgical correction of various types of AVSD in Leiden University Medical Center, Leiden. AVSD repair can be accomplished with good long-term results. Risk factors for early mortality were surgical era before 1996 and younger age at surgery. Risk factors for late reoperation were associated cardiovascular anomalies, left atrioventricular valve dysplasia, and absence of cleft closure. There was a strong decline in age at AVSD repair in the last decade, and at the same time a significant decrease in in-hospital mortality. The estimated overall survival of patients with a reoperation for LAVVR is good and comparable to that of patients not reoperated for LAVVR after AVSD repair. Yet, survival after left atrioventricular valve repair was higher than after left atrioventricular valve replacement. AVSD with DO-LAVV can be repaired with low mortality,but it is a risk factor for reoperation. A transatrial-transpulmonary approach can be used for c-AVSD-TOF repair without cardiac related mortality, limited reoperation rates and good functional outcomes in all surviviors. Artificial chordae form a useful addition to the surgical armamentarium for mitral and tricuspid valve repair in case of different anomalies of chordae tendinae