Reoperation for severe left atrioventricular regurgitation by standardized mitral repair-oriented strategy in complete atrioventricular septal defect patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Guanxi , MA Kai , QI Lei , PANG Kunjing , LIN Ye , ZHANG Benqing , RUI Lu , LIU Rui , ZHANG Sen , YANG Yang , FENG Zicong , MAO Fengqun , YUAN Jianhui ,  LI Shoujun

Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P.R.China;

Corresponding?author：

LI Shoujun, Email: drlishoujunfw@163.com

Keywords：

Complete atrioventricular septal defect; atrioventricular valve regurgitation; reoperation

DOI：

10.7507/1007-4848.202005025

Video：

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Objective To summarize the reoperation experience for complete atrioventricular septal defect (CAVSD) with severe left atrioventricular valve regurgitation (LAVVR) by standardized mitral repair-oriented strategy.Methods From 2016 to 2019, 11 CAVSD patients underwent reoperation for severe LAVVR by standardized mitral repair-oriented strategy at Fuwai Hospital, including 5 males and 6 females with a median age of 56 (22-152) months. The pathological characteristics of severe LAVVR, key points of repair technique and mid-term follow-up results were analyzed.Results The interval time between the initial surgery and this surgery was 48 (8-149) months. The aortic cross-clamp time was 54.6±21.5 min and the cardiopulmonary bypass time was 107.4±38.1 min, ventilator assistance time was 16.4±16.3 h. All patients recovered smoothly with no early or late death. The patients were followed up for 29.0±12.8 months, and the echocardiograph showed trivial to little mitral regurgitation in 5 patients, little regurgitation in 5 patients and moderate regurgitation in 1 patient. The classification (NYHA) of cardiac function was class Ⅰ in all patients.Conclusion Standardized mitral repair-oriented strategy is safe and effective in the treatment of severe LAVVR after CAVSD surgery, and the mid-term results are satisfied.

Citation： WANG Guanxi, MA Kai, QI Lei, PANG Kunjing, LIN Ye, ZHANG Benqing, RUI Lu, LIU Rui, ZHANG Sen, YANG Yang, FENG Zicong, MAO Fengqun, YUAN Jianhui, LI Shoujun. Reoperation for severe left atrioventricular regurgitation by standardized mitral repair-oriented strategy in complete atrioventricular septal defect patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(8): 959-962. doi: 10.7507/1007-4848.202005025 Copy

1.	張本青, 龔丁旭, 焦若男, 等. 先天性二尖瓣關閉不全患兒成形手術近中期結果分析. 中國循環雜志, 2020, 35(5): 500-504.
2.	Qi L, Ma K, Zhang B, et al. Pediatric mitral regurgitation: Standardized repair-oriented strategy with leaflet plication. Semin Thorac Cardiovasc Surg, 2020. [Epub ahead of print].
3.	Fong LS, Winlaw DS, Orr Y. Is the modified single-patch repair superior to the double-patch repair of complete atrioventricular septal defects? Interact Cardiovasc Thorac Surg, 2019, 28(3): 427-431.
4.	Geoffrion TR, Singappuli K, Murala JSK. A review of the Nunn modified single patch technique for atrioventricular septal defect repair. Transl Pediatr, 2018, 7(2): 91-103.
5.	Tagliari AP, Schroder DA, Teixeira Filho G, et al. Results of simplified single-patch repair for complete atrioventricular septal defect. Arq Bras Cardiol, 2013, 100(3): 288-293.
6.	黃健兵, 梅舉, 張俊文, 等. 房室間隔缺損矯治術后左側房室瓣反流的外科治療. 中國心血管病研究, 2018, 16(9): 829-832.
7.	Birim O, van Gameren M, de Jong PL, et al. Outcome after reoperation for atrioventricular septal defect repair. Interact Cardiovasc Thorac Surg, 2009, 9(1): 83-87.
8.	于冰, 楊克明, 李軒, 等. 48例兒童二尖瓣置換術的中遠期結果. 中華胸心血管外科雜志, 2016, 32(12): 750-753.
9.	劉浩, 梅舉, 湯敏, 等. 兒童心瓣膜置換術患者的臨床特點及中遠期隨訪. 中國胸心血管外科臨床雜志, 2015, 22(5): 446-449.
10.	欒果, 安永. 二尖瓣成形術治療兒童二尖瓣關閉不全的研究進展. 重慶醫學, 2019, 48(12): 2099-2101, 2106.
11.	陳俊, 孫劍, 彭衛, 等. 小兒二尖瓣關閉不全瓣膜成形術的臨床療效分析. 臨床小兒外科雜志, 2020, 19(6): 513-517.
12.	Ten Harkel AD, Cromme-Dijkhuis AH, Heinerman BC, et al. Development of left atrioventricular valve regurgitation after correction of atrioventricular septal defect. Ann Thorac Surg, 2005, 79(2): 607-612.
13.	Fortuna RS, Ashburn DA, Carias De Oliveira N, et al. Atrioventricular septal defects: Effect of bridging leaflet division on early valve function. Ann Thorac Surg, 2004, 77(3): 895-902.
14.	Kanani M, Elliott M, Cook A, et al. Late incompetence of the left atrioventricular valve after repair of atrioventricular septal defects: The morphologic perspective. J Thorac Cardiovasc Surg, 2006, 132(3): 640-646.
15.	Yakub MA, Krishna Moorthy PS, Sivalingam S, et al. Contemporary long-term outcomes of an aggressive approach to mitral valve repair in children: Is it effective and durable for both congenital and acquired mitral valve lesions? Eur J Cardiothorac Surg, 2016, 49(2): 553-560.
16.	Kalfa D, Vergnat M, Ly M, et al. A standardized repair-oriented strategy for mitral insufficiency in infants and children: Midterm functional outcomes and predictors of adverse events. J Thorac Cardiovasc Surg, 2014, 148(4): 1459-1466.
17.	Backer CL, Mavroudis C, Alboliras ET, et al. Repair of complete atrioventricular canal defects: Results with the two-patch technique. Ann Thorac Surg, 1995, 60(3): 530-537.
18.	Prifti E, Bonacchi M, Baboci A, et al. Surgical outcome of reoperation due to left atrioventricular valve regurgitation after previous correction of complete atrioventricular septal defect. J Card Surg, 2013, 28(6): 756-763.
19.	Najm HK, Coles JG, Endo M, et al. Complete atrioventricular septal defects: Results of repair, risk factors, and freedom from reoperation. Circulation, 1997, 96(9 Suppl): 311-315.
20.	Moran AM, Daebritz S, Keane JF, et al. Surgical management of mitral regurgitation after repair of endocardial cushion defects: Early and midterm results. Circulation, 2000, 102(19 Suppl 3): 160-165.
21.	Alexi-Meskishvili V, Hetzer R, Dahnert I, et al. Results of left atrioventricular valve reconstruction after previous correction of atrioventricular septal defects. Eur J Cardiothorac Surg, 1997, 12(3): 460-465.
22.	楚軍民, 徐海濤, 李守軍, 等. 完全性房室間隔缺損修補術后再次手術的早中期結果. 中國分子心臟學雜志, 2016, 16(1): 1570-1572.

1. 張本青, 龔丁旭, 焦若男, 等. 先天性二尖瓣關閉不全患兒成形手術近中期結果分析. 中國循環雜志, 2020, 35(5): 500-504.
2. Qi L, Ma K, Zhang B, et al. Pediatric mitral regurgitation: Standardized repair-oriented strategy with leaflet plication. Semin Thorac Cardiovasc Surg, 2020. [Epub ahead of print].
3. Fong LS, Winlaw DS, Orr Y. Is the modified single-patch repair superior to the double-patch repair of complete atrioventricular septal defects? Interact Cardiovasc Thorac Surg, 2019, 28(3): 427-431.
4. Geoffrion TR, Singappuli K, Murala JSK. A review of the Nunn modified single patch technique for atrioventricular septal defect repair. Transl Pediatr, 2018, 7(2): 91-103.
5. Tagliari AP, Schroder DA, Teixeira Filho G, et al. Results of simplified single-patch repair for complete atrioventricular septal defect. Arq Bras Cardiol, 2013, 100(3): 288-293.
6. 黃健兵, 梅舉, 張俊文, 等. 房室間隔缺損矯治術后左側房室瓣反流的外科治療. 中國心血管病研究, 2018, 16(9): 829-832.
7. Birim O, van Gameren M, de Jong PL, et al. Outcome after reoperation for atrioventricular septal defect repair. Interact Cardiovasc Thorac Surg, 2009, 9(1): 83-87.
8. 于冰, 楊克明, 李軒, 等. 48例兒童二尖瓣置換術的中遠期結果. 中華胸心血管外科雜志, 2016, 32(12): 750-753.
9. 劉浩, 梅舉, 湯敏, 等. 兒童心瓣膜置換術患者的臨床特點及中遠期隨訪. 中國胸心血管外科臨床雜志, 2015, 22(5): 446-449.
10. 欒果, 安永. 二尖瓣成形術治療兒童二尖瓣關閉不全的研究進展. 重慶醫學, 2019, 48(12): 2099-2101, 2106.
11. 陳俊, 孫劍, 彭衛, 等. 小兒二尖瓣關閉不全瓣膜成形術的臨床療效分析. 臨床小兒外科雜志, 2020, 19(6): 513-517.
12. Ten Harkel AD, Cromme-Dijkhuis AH, Heinerman BC, et al. Development of left atrioventricular valve regurgitation after correction of atrioventricular septal defect. Ann Thorac Surg, 2005, 79(2): 607-612.
13. Fortuna RS, Ashburn DA, Carias De Oliveira N, et al. Atrioventricular septal defects: Effect of bridging leaflet division on early valve function. Ann Thorac Surg, 2004, 77(3): 895-902.
14. Kanani M, Elliott M, Cook A, et al. Late incompetence of the left atrioventricular valve after repair of atrioventricular septal defects: The morphologic perspective. J Thorac Cardiovasc Surg, 2006, 132(3): 640-646.
15. Yakub MA, Krishna Moorthy PS, Sivalingam S, et al. Contemporary long-term outcomes of an aggressive approach to mitral valve repair in children: Is it effective and durable for both congenital and acquired mitral valve lesions? Eur J Cardiothorac Surg, 2016, 49(2): 553-560.
16. Kalfa D, Vergnat M, Ly M, et al. A standardized repair-oriented strategy for mitral insufficiency in infants and children: Midterm functional outcomes and predictors of adverse events. J Thorac Cardiovasc Surg, 2014, 148(4): 1459-1466.
17. Backer CL, Mavroudis C, Alboliras ET, et al. Repair of complete atrioventricular canal defects: Results with the two-patch technique. Ann Thorac Surg, 1995, 60(3): 530-537.
18. Prifti E, Bonacchi M, Baboci A, et al. Surgical outcome of reoperation due to left atrioventricular valve regurgitation after previous correction of complete atrioventricular septal defect. J Card Surg, 2013, 28(6): 756-763.
19. Najm HK, Coles JG, Endo M, et al. Complete atrioventricular septal defects: Results of repair, risk factors, and freedom from reoperation. Circulation, 1997, 96(9 Suppl): 311-315.
20. Moran AM, Daebritz S, Keane JF, et al. Surgical management of mitral regurgitation after repair of endocardial cushion defects: Early and midterm results. Circulation, 2000, 102(19 Suppl 3): 160-165.
21. Alexi-Meskishvili V, Hetzer R, Dahnert I, et al. Results of left atrioventricular valve reconstruction after previous correction of atrioventricular septal defects. Eur J Cardiothorac Surg, 1997, 12(3): 460-465.
22. 楚軍民, 徐海濤, 李守軍, 等. 完全性房室間隔缺損修補術后再次手術的早中期結果. 中國分子心臟學雜志, 2016, 16(1): 1570-1572.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Reoperation for severe left atrioventricular regurgitation by standardized mitral repair-oriented strategy in complete atrioventricular septal defect patients

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