Modified single-patch versus double-patch repair in complete atrioventricular septal defect: a comparative study of surgical and long-term outcomes
Abstract
Aims: Complete atrioventricular septal defect (CAVSD) is a complex congenital cardiac anomaly, accounting for 3–4% of all congenital heart diseases and frequently associated with Trisomy 21. It involves a common atrioventricular valve (AVV) and large septal defects, often necessitating early surgical intervention to prevent irreversible pulmonary vascular disease. While the double-patch technique (DPT) has been widely used for decades, the modified single-patch technique (MSPT) has recently gained popularity due to its technical simplicity and reduced manipulation of the AVV. However, comparative data on the short- and long-term outcomes of these two approaches remain limited. This study aimed to compare the early and long-term clinical results of the MSPT and DPT, focusing on postoperative mortality and AVV regurgitation.
Methods: We conducted a retrospective review of 56 patients who underwent complete CAVSD repair between 2009 and 2023 at a single center. Thirty-seven patients (66%) were treated with MSPT, and 19 patients (34%) with DPT. Patient demographics, perioperative data, postoperative complications, mortality, and long-term outcomes were evaluated. The mean follow-up duration among 45 patients was 73.2±4.1 months.
Results: The MSPT group had a significantly younger median age (7.5 vs. 14 months; p=0.003) and smaller ventricular septal defect (VSD) diameters (8.2 mm vs. 13.8 mm; p<0.001) than the DPT group. Cardiopulmonary bypass (CPB) and aortic crossclamp (ACC) times were significantly shorter in the MSPT group (p<0.001). Moderate-to-severe early postoperative left AVV (LAVV) regurgitation was more frequent in the DPT group (p=0.016), while postoperative drainage volume was significantly higher in the DPT group as well (p=0.019). Early postoperative mortality occurred in 2 patients (3.5%) overall, and the total mortality for the entire cohort was 11.1%, with no statistically significant difference observed between the MSPT and DPT Reoperation due to progressive LAVV regurgitation occurred in 3 patients (6.6%)—1 in the MSPT and 2 in the DPT group—again without statistical significance. No cases of left ventricular outflow tract obstruction were observed in either group.
Conclusion: Our findings suggest that MSPT, with its simplicity and favorable outcomes, may be an effective surgical technique for selected CAVSD patients, particularly those with smaller VSDs. Compared to DPT, it is associated with shorter operative times and a significantly lower rate of early moderate-to-severe LAVV regurgitation, while offering comparable long-term mortality and reoperation rates.
Keywords
Complete atrioventricular septal defect congenital heart disease modified single-patch technique Trisomy 21
Ethical Statement
The study protocol was approved by the institutional review board of the Anadolu Medical Center, Kocaeli, Turkey (no, ASM-EK-25/292; date, March 19, 2025); and the study was conducted in accordance with the Declaration of Helsinki
References
- Lev M. The architecture of the conduction system in congenital heart disease. I. Common atrioventricular orifice. AMA Arch Pathol. 1958; 65(2):174-191.
- Gerbode F. Surgical repair of endocardial cushion defect. Ann Chir Thorac Cardiovasc. 1962;1:753-755.
- Backer CL, Mavroudis C. Atrioventricular canal defects. In: Mavroudis C, Backer CL, eds. Pediatric Cardiac Surgery. 3rd ed. Philadelphia: Mosby; 2003.
- Mitchell SC, Korones SB, Berendes HW. Congenital heart disease in 56.109 live births. Incidence and natural history. Circulation. 1971;43(3): 323-332. doi:10.1161/01.cir.43.3.323
- Spicer RL. Cardiovascular disease in Down syndrome. Pediatr Clin North Am. 1984;31(6):1331-1343. doi:10.1016/s0031-3955(16)34725-3
- Rastelli G, Kirklin JW, Titus JL. Anatomic observations on complete form of persistent common atrioventricular canal with special reference to atrioventricular valves. Mayo Clin Proc. 1966;41(5):296-308.
- Trachte AL, Lobato EB, Urdaneta F, et al. Oral sildenafil reduces pulmonary hypertension after cardiac surgery. Ann Thorac Surg. 2005; 79(1):194-197. doi:10.1016/j.athoracsur.2004.06.086
- Nunn GR. Atrioventricular canal: modified single patch technique. Pediatr Card Surg Annu. 2007;10:28-31. doi:10.1053/j.pcsu.2007.01.009
- Kobayashi M, Takahashi Y, Ando M. Ideal timing of surgical repair of isolated complete atrioventricular septal defect. Interact Cardiovasc Thorac Surg. 2007;6(1):24-26. doi:10.1510/icvts.2006.134288
- Mills NL, Ochsner JL, King TD. Correction of Type C complete atrioventricular canal. Surgical considerations. J Thorac Cardiovasc Surg. 1976;71(1):20-28. doi:10.1016/S0022-5223(19)40256-0
- Meskishvili VA, İshino K, Dahnert I, et al. Correction of complete atrioventricular septal defects with the double-patch technique and cleft closure. Ann Thorac Surg. 1996;62(2):519-525. doi:10.1016/0003-4975(96)00319-0
- Atz AM, Hawkins JA, Lu M, et al. Surgical management of complete atrioventricular septal defect: associations with surgical technique, age, and trisomy 21. J Thorac Cardiovasc Surg. 2011;141(6):1371-1379. doi:10. 1016/j.jtcvs.2010.08.093
- Xie O, Brizard CP, d'Udekem Y, et al. Outcomes of repair of complete atrioventricular septal defect in the current era. Eur J Cardiothorac Surg. 2014;45(4):610-617. doi:10.1093/ejcts/ezt444
- Tumanyan MR, Filaretova OV, Chechneva VV, Gulasaryan RS. Repair of complete atrioventricular septal defect in infants with Down syndrome: outcomes and long-term results. Pediatr Cardiol. 2015;36(1):71-75. doi: 10.1007/s00246-014-0966-7
- Bakhtiary F, Takacs J, Cho MY, et. Al. Long-term results after repair of complete atrioventricular septal defect with two-patch technique. Ann Thorac Surg. 2010;89(4):1239-1243. doi:10.1016/j.athoracsur.2009.11.017
- Li D, Fan Q, Iwase T, Hirata Y. Modified single-patch technique versus two-patch technique for the repair of complete atrioventricular septal defect: a meta-analysis. Pediatr Cardiol. 2017;38(7):1456-1464. doi:10. 1007/s00246-017-1684-8
- Jeong IS, Lee CH, Lee C, et al. Surgical outcomes of the modified single patch technique in complete atrioventricular septal defect. Interactive Cardiovasc Thoracic Surg. 2009;8(4):435-438. doi:10.1510/icvts.2008. 192872
- Pan G, Song L, Zhou X, Zhao J. Complete atrioventricular septal defect: comparison of modified single-patch technique with two-patch technique in infants. J Card Surg. 2014;29(2):251-255. doi:10.1111/jocs. 12295
- Ginde S, Lam J, Garick DH, et al. Long term outcomes after surgical repair of complete atrioventricular defect. J Thorac Cardiovasc Surg. 2015;150(2):369-374. doi:10.1016/j.jtcvs.2015.05.011
- Prifti E, Bonacchi M, Baboci A, Giunti G. 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. doi:10.1111/jocs.12231
- Harmandar B, AydemirNA, Karaci AR, et al. Results for surgical correctionof complete atrioventricular septal defect: associations with age, surgical era and technique. J Card Surg. 2012;27(6):745-753. doi:10. 1111/jocs.12016
- Salihoğlu E, Özkan S, Özçobanoğlu S, et al. Preliminary results of direct closure of an atrioventricular septal defect: revisiting the original technique. Turk J Thorac Cardiovasc Surg. 2012;20(4):699-704. doi:10. 5606/tgkdc.dergisi.2012.141
- Li D, Fan Q, Iwase T, et al. Modified single patch technique versus two patch technique for the repair of complete atrioventricular septal defect: a meta-analysis. Pediatr Cardiol. 2017;38(7):1456-1464. doi:10.1007/s00246-017-1684-8
- Draguescu A, Fouilloux V, Ghez O, et al. Complete atrioventricular canal repair under 1 year: Rastelli one-patch procedure yields excellent long term results. Ann Thorac Surg. 2008;86(5):1599-1606. doi:10.1016/j.athoracsur.2008.07.002
- Prifti E, Bonacchi M, Bernabei M, et al. Repair of complete atrioventricular septal defect with tetralogy of fallot. J Card Surg. 2004; 19(2):175-183. doi:10.1111/j.0886-0440.2004.04031.x
- Backer CL. Commentary: defining the limits of the modified single-patch technique. J Thorac Cardiovasc Surg. 2023;165(2):422-423. doi:10. 1016/j.jtcvs.2022.08.011
- Kobayashi Y, Kasahara S, Sano S, Kotani Y. Modifiedsingle-patch repair for atrio-ventricular septal defects results in good functional outcomes in the absence of deep ventricular septal defects. J Thorac Cardiovasc Surg. 2023;165(2):411-421. doi:10.1016/j.jtcvs.2022.07.041
Abstract
References
- Lev M. The architecture of the conduction system in congenital heart disease. I. Common atrioventricular orifice. AMA Arch Pathol. 1958; 65(2):174-191.
- Gerbode F. Surgical repair of endocardial cushion defect. Ann Chir Thorac Cardiovasc. 1962;1:753-755.
- Backer CL, Mavroudis C. Atrioventricular canal defects. In: Mavroudis C, Backer CL, eds. Pediatric Cardiac Surgery. 3rd ed. Philadelphia: Mosby; 2003.
- Mitchell SC, Korones SB, Berendes HW. Congenital heart disease in 56.109 live births. Incidence and natural history. Circulation. 1971;43(3): 323-332. doi:10.1161/01.cir.43.3.323
- Spicer RL. Cardiovascular disease in Down syndrome. Pediatr Clin North Am. 1984;31(6):1331-1343. doi:10.1016/s0031-3955(16)34725-3
- Rastelli G, Kirklin JW, Titus JL. Anatomic observations on complete form of persistent common atrioventricular canal with special reference to atrioventricular valves. Mayo Clin Proc. 1966;41(5):296-308.
- Trachte AL, Lobato EB, Urdaneta F, et al. Oral sildenafil reduces pulmonary hypertension after cardiac surgery. Ann Thorac Surg. 2005; 79(1):194-197. doi:10.1016/j.athoracsur.2004.06.086
- Nunn GR. Atrioventricular canal: modified single patch technique. Pediatr Card Surg Annu. 2007;10:28-31. doi:10.1053/j.pcsu.2007.01.009
- Kobayashi M, Takahashi Y, Ando M. Ideal timing of surgical repair of isolated complete atrioventricular septal defect. Interact Cardiovasc Thorac Surg. 2007;6(1):24-26. doi:10.1510/icvts.2006.134288
- Mills NL, Ochsner JL, King TD. Correction of Type C complete atrioventricular canal. Surgical considerations. J Thorac Cardiovasc Surg. 1976;71(1):20-28. doi:10.1016/S0022-5223(19)40256-0
- Meskishvili VA, İshino K, Dahnert I, et al. Correction of complete atrioventricular septal defects with the double-patch technique and cleft closure. Ann Thorac Surg. 1996;62(2):519-525. doi:10.1016/0003-4975(96)00319-0
- Atz AM, Hawkins JA, Lu M, et al. Surgical management of complete atrioventricular septal defect: associations with surgical technique, age, and trisomy 21. J Thorac Cardiovasc Surg. 2011;141(6):1371-1379. doi:10. 1016/j.jtcvs.2010.08.093
- Xie O, Brizard CP, d'Udekem Y, et al. Outcomes of repair of complete atrioventricular septal defect in the current era. Eur J Cardiothorac Surg. 2014;45(4):610-617. doi:10.1093/ejcts/ezt444
- Tumanyan MR, Filaretova OV, Chechneva VV, Gulasaryan RS. Repair of complete atrioventricular septal defect in infants with Down syndrome: outcomes and long-term results. Pediatr Cardiol. 2015;36(1):71-75. doi: 10.1007/s00246-014-0966-7
- Bakhtiary F, Takacs J, Cho MY, et. Al. Long-term results after repair of complete atrioventricular septal defect with two-patch technique. Ann Thorac Surg. 2010;89(4):1239-1243. doi:10.1016/j.athoracsur.2009.11.017
- Li D, Fan Q, Iwase T, Hirata Y. Modified single-patch technique versus two-patch technique for the repair of complete atrioventricular septal defect: a meta-analysis. Pediatr Cardiol. 2017;38(7):1456-1464. doi:10. 1007/s00246-017-1684-8
- Jeong IS, Lee CH, Lee C, et al. Surgical outcomes of the modified single patch technique in complete atrioventricular septal defect. Interactive Cardiovasc Thoracic Surg. 2009;8(4):435-438. doi:10.1510/icvts.2008. 192872
- Pan G, Song L, Zhou X, Zhao J. Complete atrioventricular septal defect: comparison of modified single-patch technique with two-patch technique in infants. J Card Surg. 2014;29(2):251-255. doi:10.1111/jocs. 12295
- Ginde S, Lam J, Garick DH, et al. Long term outcomes after surgical repair of complete atrioventricular defect. J Thorac Cardiovasc Surg. 2015;150(2):369-374. doi:10.1016/j.jtcvs.2015.05.011
- Prifti E, Bonacchi M, Baboci A, Giunti G. 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. doi:10.1111/jocs.12231
- Harmandar B, AydemirNA, Karaci AR, et al. Results for surgical correctionof complete atrioventricular septal defect: associations with age, surgical era and technique. J Card Surg. 2012;27(6):745-753. doi:10. 1111/jocs.12016
- Salihoğlu E, Özkan S, Özçobanoğlu S, et al. Preliminary results of direct closure of an atrioventricular septal defect: revisiting the original technique. Turk J Thorac Cardiovasc Surg. 2012;20(4):699-704. doi:10. 5606/tgkdc.dergisi.2012.141
- Li D, Fan Q, Iwase T, et al. Modified single patch technique versus two patch technique for the repair of complete atrioventricular septal defect: a meta-analysis. Pediatr Cardiol. 2017;38(7):1456-1464. doi:10.1007/s00246-017-1684-8
- Draguescu A, Fouilloux V, Ghez O, et al. Complete atrioventricular canal repair under 1 year: Rastelli one-patch procedure yields excellent long term results. Ann Thorac Surg. 2008;86(5):1599-1606. doi:10.1016/j.athoracsur.2008.07.002
- Prifti E, Bonacchi M, Bernabei M, et al. Repair of complete atrioventricular septal defect with tetralogy of fallot. J Card Surg. 2004; 19(2):175-183. doi:10.1111/j.0886-0440.2004.04031.x
- Backer CL. Commentary: defining the limits of the modified single-patch technique. J Thorac Cardiovasc Surg. 2023;165(2):422-423. doi:10. 1016/j.jtcvs.2022.08.011
- Kobayashi Y, Kasahara S, Sano S, Kotani Y. Modifiedsingle-patch repair for atrio-ventricular septal defects results in good functional outcomes in the absence of deep ventricular septal defects. J Thorac Cardiovasc Surg. 2023;165(2):411-421. doi:10.1016/j.jtcvs.2022.07.041
Details
| Primary Language | English |
|---|---|
| Subjects | Cardiovascular Medicine and Haematology (Other) |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | May 30, 2025 |
| Submission Date | April 22, 2025 |
| Acceptance Date | May 27, 2025 |
| Published in Issue | Year 2025 Volume: 7 Issue: 3 |
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