The Application of On-Pump Beating-Heart Surgery for Partial Atrioventricular Septal Defect: A Report of 87 Cases

Authors

  • Lin Chen
  • Jia Hao
  • Rui-Yan Ma
  • Bai-Cheng Chen
  • Wei Cheng
  • Chuan Qin
  • Xue-Feng Wang
  • Ying-Bin Xiao

DOI:

https://doi.org/10.1532/HSF98.2013217

Abstract

Background: Partial atrioventricular septal defect (P-AVSD) is a common congenital heart disease. Because of the presence of left and right atrioventricular valve deformities and the shift in the atrioventricular node and cardiac conduction bundle, the surgical repair of P-AVSD is difficult. This study was performed to compare the effects on the coronary sinus septum in the left versus the right atrium during surgical treatment for P-AVSD and report our experiences regarding the application of on-pump beating heart surgery under mild hypothermia for patients with P-AVSD.

Materials and Methods: The effects of on-pump beating heart surgery were analyzed retrospectively in 87 P-AVSD patients. Of the 87 total patients, 84 with anterior mitral leaflet cleft underwent valvuloplasty and 3 underwent mitral valve replacement. Seventy-seven patients underwent tricuspid valve annuloplasty, 2 underwent tricuspid valve replacement, and 1 underwent left superior vena cava ligation, and 3 patients with atrial fibrillation were treated with radiofrequency ablation. Patients with an ostium primum atrial septal defect underwent autologous pericardial modified Kirklin repair. Of these, 46 patients had their coronary sinus septum separated into the left atrium and 41 had their coronary sinus retained in the right atrium. Fingertip oxygen saturation was compared between patients in whom the coronary sinus was separated to the left atrium and those in whom the coronary sinus was retained in the right atrium.

Results: There was 1 postoperative early death (1.15%) due to respiratory failure, and 1 patient had a III degree atrioventricular block (1.15%) and underwent implantation of a permanent pacemaker. The fingertip oxygen saturation levels of the left atrium group were 96.81 ± 3.17 preoperatively, 95.37 ± 4.62 at 7 days postoperatively, and 94.53 ± 4.95 at 3 months postoperatively. Those of the right atrium group were 98.53 ± 2.84 preoperatively, 97.19 ± 3.57 at 7 days postoperatively, and 96.89 ± 4.19 at 3 months postoperatively. During the follow-up period, which ranged from 3 months to 7 years, the cardiac function was adequately restored.

Conclusions: On-pump beating heart surgery under mild hypothermia is a safe and feasible method. The retention of the coronary sinus in the right atrium might maintain oxygen saturation.

References

Chowdhury UK, Airan B, Malhotra A, et al. 2009. Specific issues after surgical repair of partial atrioventricular septal defect: actuarial survival, freedom from reoperation, fate of the left atrioventricular valve, prevalence of left ventricular outflow tract obstruction, and other events. J Thorac Cardiovasc Surg 137:548-55.nEl-Najdawi EK, Driscoll DJ, Puga FJ, et al. 2000. Operation for partial atrioventricular septal defect: a forty-year review. J Thorac Cardiovasc Surg 119:880-90.nMavroudis C and Backer CL. 2004 Atrioventricular septal defect: complete. In: Mavroudis C, Backer CL, eds. Pediatric cardiac surgery 3rd ed. Singapore: Elsevier (Singapore). 396-413.nMinich LL, Atz AM, Colan SD, et al. 2010. Pediatric Heart Network Investigators. Partial and transitional atrioventricular septal defect outcomes. Ann Thorac Surg 89:253-536.nMo AS, Lin H. 2011. On-pump beating heart surgery. Heart Lung Circ 20:295-304.nPadala M, Vasilyev NV, Owen JW Jr, et al. 2008. Cleft closure and undersizing annuloplasty improve mitral repair in atrioventricular canal defects. J Thorac Cardiovasc Surg 136:1243-9.nShinebourne EA, Ho SY. 2011. Atrioventricular septal defect: complete and partial (ostium primum atrial septal defect). In: Colman JM, Oechslin E, Taylor DA, eds. Diagnosis and management of adult congenital heart disease. 2nd ed. New York: Churchill Livingstone. 196-203.nSims JB, Roberts WC. 2006. Comparison of findings in patients with versus without atrial fibrillation just before isolated mitral valve replacement for rheumatic mitral stenosis (with or without associated mitral regurgitation). Am J Cardio 97:1035-8.nStulak JM, Burkhart HM, Dearani JA, et al. 2010. Reoperations after repair of partial atrioventricular septal defect: a 45-year single-center experience. Ann Thorac Surg 89:1352-9.nTekin G, Tekin A, Y?ld?r?m SV, Yi it F. 2007. Long-term survival with partial atrioventricular septal defect. Int J Cardiol 115:e116-7.nXiao YB, Chen L, Wang XF, et al. 2001. Clinical analysis of on-pump beating heart intracardiac procedures in 1032 cases. Acta Academiae Medicine Militaris Tertiae. 23:502-4.n

Published

2013-11-11

How to Cite

Chen, L., Hao, J., Ma, R.-Y., Chen, B.-C., Cheng, W., Qin, C., Wang, X.-F., & Xiao, Y.-B. (2013). The Application of On-Pump Beating-Heart Surgery for Partial Atrioventricular Septal Defect: A Report of 87 Cases. The Heart Surgery Forum, 16(5), E257-E263. https://doi.org/10.1532/HSF98.2013217

Issue

Section

Articles