Modified single-patch compared with two-patch repair of complete atrioventricular septal defect.

Background. We compared the outcomes of modified single-patch and two-patch surgical repair of complete atrioventricular septal defect (CAVSD) on left ventricular outflow tract (LVOT) diameter and on left atrioventricular valve (LAVV) coaptation. Methods. We reviewed retrospectively postoperative 2-dimensional echocardiograms of all CAVSD patients who underwent modified single-patch or two-patch repair between 2005 and 2011. We measured the leaflet coaptation length of the LAVV in the apical four-chamber view. The LVOT was measured in the long axis view. Results. Fifty-one patients underwent CAVSD repair at a median age of 4 months (range, 1 to 9 months) (single-patch, n = 29; two-patch, n = 22). The images from 46 echocardiograms were adequate for analysis. Modified single-patch repair required significantly shorter bypass time (102.0 +/- 33.6 vs 152.9 +/- 39.5 minutes, p < 0.001) and ischemic time (69.0 +/- 21.7 vs 106.9 +/- 29.7 minutes, p < 0.001) than did two-patch repair. The indexed coaptation length of the septal and lateral leaflets was not different between single-patch and two-patch (3.1 +/- 2.3 vs 4.1 +/- 3.1 mm/m(2), p = 0.25; 2.3 +/- 2.3 vs 3.3 +/- 3.0 mm/m(2), p = 0.21). Indexed LVOT diameter was not different in the two groups (26.1 +/- 5.2 vs 28.5 +/- 7.1 mm/m(2), p = 0.22). There was no hospital or late death during the median follow-up time of 35 months (range, 1 to 69 months). Five patients underwent reoperation after single-patch repair (3 with residual ventricular septal defect [VSD] and LAVV regurgitation, 1 with residual VSD, 1 with pacemaker implantation). After the two-patch repair, 1 patient required reoperation for a residual VSD and right atrioventricular valve regurgitation (p = 0.22). Conclusions. The modified single-patch repair was performed with significantly shorter bypass time and myocardial ischemic time. The postoperative LVOT diameter and LAVV leaflet coaptation length were not significantly different between techniques. (C) 2014 by The Society of Thoracic Surgeons