Cleft closure and other predictors of contemporary outcomes after atrioventricular canal repair in patients with parachute left atrioventricular valve

Patrick B McGeoghegan; Minmin Lu; Lynn A Sleeper; Sitaram M Emani; Christopher W Baird; Eric N Feins; Laura A Gellis; Kevin G Friedman

doi:10.1093/icvts/ivae048

Cleft closure and other predictors of contemporary outcomes after atrioventricular canal repair in patients with parachute left atrioventricular valve

Interdiscip Cardiovasc Thorac Surg. 2024 Mar 29;38(4):ivae048. doi: 10.1093/icvts/ivae048.

Authors

Patrick B McGeoghegan¹, Minmin Lu¹, Lynn A Sleeper¹, Sitaram M Emani², Christopher W Baird², Eric N Feins², Laura A Gellis¹, Kevin G Friedman¹

Affiliations

¹ Department of Cardiology, Children's Hospital Boston, Boston, MA, USA.
² Department of Cardiothoracic Surgery, Children's Hospital Boston, Boston, MA, USA.

Abstract

Objectives: Parachute left atrioventricular valve (LAVV) complicates atrioventricular septal defect (AVSD) repair. We evaluate outcomes of AVSD patients with parachute LAVV and identify risk factors for adverse outcomes.

Methods: We evaluated all patients undergoing repair of AVSD with parachute LAVV from 2012 to 2021. The primary outcome was a composite of time-to-death, LAVV reintervention and development of greater than or equal to moderate LAVV dysfunction (greater than or equal to moderate LAVV stenosis and/or LAVV regurgitation). Event-free survival for the composite outcome was estimated using Kaplan-Meier methodology and competing risks analysis. Cox proportional hazards regression was used to identify predictors of the primary outcome.

Results: A total of 36 patients were included with a median age at repair of 4 months (interquartile range 2.3-5.5 months). Over a median follow-up of 2.6 years (interquartile range 1.0-5.6 years), 6 (17%) patients underwent LAVV reintervention. All 6 patients who underwent LAVV reintervention had right-dominant AVSD. Sixteen patients (44%) met the composite outcome, and all did so within 2 years of initial repair. Transitional AVSD (versus complete), prior single-ventricle palliation, leaving the cleft completely open and greater than or equal to moderate preoperative LAVV regurgitation were associated with a higher risk of LAVV reintervention in univariate analysis. In multivariate analysis, leaving the cleft completely open was associated with the composite outcome.

Conclusions: Repair of AVSD with parachute LAVV remains a challenge with a significant burden of LAVV reintervention and dysfunction in medium-term follow-up. Unbalanced, right-dominant AVSDs are at higher risk for LAVV reintervention. Leaving the cleft completely open might independently predict poor overall outcomes and should be avoided when possible.

Clinical trial registration number: IRB-P00041642.

Keywords: Atrioventricular septal defect; Cleft; Left atrioventricular valve; Parachute.