Back to Search
Start Over
Surgical management of neonatal atrioventricular septal defect with aortic arch obstruction.
- Source :
-
The Annals of thoracic surgery [Ann Thorac Surg] 2013 Jun; Vol. 95 (6), pp. 2071-7. Date of Electronic Publication: 2013 Feb 14. - Publication Year :
- 2013
-
Abstract
- Background: For neonates with atrioventricular septal defect and aortic arch obstruction including coarctation of the aorta, we sought to determine whether a difference in outcomes exists after a primary neonatal versus staged surgical repair (neonatal arch repair with delayed intracardiac repair).<br />Methods: This retrospective cohort study included consecutive neonates with atrioventricular septal defect and aortic arch obstruction who underwent cardiac surgery before 28 days of age at six centers from 1990 to 2009. Characteristics and outcomes between patients undergoing neonatal versus staged repair were compared.<br />Results: Of 66 study patients, 31 (47%) underwent primary neonatal repair and 35 (53%) underwent staged repair. At baseline echocardiogram, a greater percentage of neonatal repair patients had relative unbalanced ventricular size (56% versus 35%, p = 0.02). There were no other differences in demographic characteristics, cardiac anatomical or functional details, or surgical technique. Those undergoing neonatal repair tended to be more likely to have at least moderate left atrioventricular valve regurgitation early after repair (42% versus 19%, p = 0.05) and to have at least one major in-hospital complication (42% versus 20%, p = 0.06). After the initial cardiac operation, compared with the neonatal repair group, patients undergoing staged repair had greater survival (87% versus 57% at 6 years, log-rank p = 0.02) and freedom from the first unplanned cardiac reoperation (69% versus 45% at 6 years, log-rank p = 0.005).<br />Conclusions: For neonates with atrioventricular septal defect and aortic arch obstruction, when compared with neonatal repair, a staged approach was associated with improved survival and lower morbidity.<br /> (Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Abnormalities, Multiple diagnosis
Abnormalities, Multiple mortality
Abnormalities, Multiple surgery
Aorta, Thoracic abnormalities
Aortic Coarctation diagnosis
Aortic Coarctation mortality
Aortic Coarctation surgery
Cardiac Surgical Procedures mortality
Cohort Studies
Combined Modality Therapy
Education, Medical, Continuing
Female
Follow-Up Studies
Heart Septal Defects, Ventricular mortality
Humans
Infant, Newborn
Kaplan-Meier Estimate
Male
Multivariate Analysis
Postoperative Complications mortality
Postoperative Complications physiopathology
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Statistics, Nonparametric
Survival Rate
Treatment Outcome
Vascular Surgical Procedures mortality
Aorta, Thoracic surgery
Cardiac Surgical Procedures methods
Heart Septal Defects, Ventricular surgery
Hospital Mortality
Vascular Surgical Procedures methods
Subjects
Details
- Language :
- English
- ISSN :
- 1552-6259
- Volume :
- 95
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The Annals of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 23415240
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2012.11.069