Comparision of Two Techniques Used in Complete Atrioventricular Septal Defects: A Systematic Review and Meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANGYi ,  MOXu-ming , QIJi-rong

Department of Cardiothoracic Surgery, Nanjing Children's Hospital, Nanjing 210008, P. R. China;

Corresponding author：

MOXu-ming, Email: mohsuming15@sina.com

Keywords：

Complete atrioventricular septal defect(CAVSD); Two-patch technique; Modified single-patch technique; Systematic review/Meta-analysis

DOI：

10.7507/1007-4848.20160274

Video：

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Objective To systemically evaluate the advantage of simplified single-patch technique used in complete atrioventricular septal defects. Methods A systematic literature search was conducted in PubMed, Annual Reviews, CNKI, Wanfang Data Libraries and Read Show Academic Search, and the retrieval date was March 2016. The literatures were screened and assessed according to inclusion criteria, and analyzed by meta-analysis STATA 11.0 software. The results were represented in standard mean difference (SMD), risk ratio (RR) and 95% confidence interval (CI). Results Compared with the two-patch technique group, in the simplified single-patch technique group cardiopulmonary bypass time, aortic clamping time, the length of hospital stay and the ICU stay as well as the mortality rate were satistically less (SMD=-0.93, 95% CI -1.24, -0.61, P=0.000; SMD=-1.02, 95% CI -1.39, -0.66, P=0.000; SMD=-0.10, 95% CI -0.43, -0.23, P=0.035; SMD=-0.12, 95% CI -0.29, -0.05, P=0.555; RR=0.93, 95% CI 0.66, 1.30, P=0.031, respectively). While there was no statistical difference in the reoperation rate (RR=0.87, 95% CI 0.65, 1.17, P=0.398). Conclusion Simplified single-patch technique has dominant superiority in operation time, ICU stay, mortality rate, and correlative complications induced by extracorporeal circulation. However, difference in reoperation rate is not significant.

Citation： ZHANGYi, MOXu-ming, QIJi-rong. Comparision of Two Techniques Used in Complete Atrioventricular Septal Defects: A Systematic Review and Meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(12): 1162-1171. doi: 10.7507/1007-4848.20160274 Copy

1.	李守军, 高峰, 吴清玉, 等. 完全性房室通道的外科治疗. 中华胸心血管外科杂志, 2005, 12(5): 323-325.
2.	Najm HK, Coles JG, Endo M, et al. Complete atrioventricular septal defects: results of repair, risk factors, and freedom from reoperation. Circulation, 1997, 96(9Suppl): 829-835.
3.	Samaánek M. Prevalence at birth, "natural" risk and survival with atrioventricular septal defect. Cardiol Young, 1991, 1(1): 285-289.
4.	Reddy VM, McElhinney DB, Brook MM. et al. Atrioventricular valve function after single patch repair of complete atrioventricular septal defect in infancy: how early should repair be attempted? J Thorac Cardiovasc Surg, 1998, 115(5): 1032-1040.
5.	Trusler GA, Mills NL, Ochsner JL, et al. Correction of Type C comp-lete atrioventricular canal. J Thorac Cardiovasc Surg, 1976, 71(1): 20-28.
6.	Alexi-Meskishvili V, Ishino K, Dähnert I, et al. Correction of comp-lete atrioventricular septal defects with the double-patch technique and cleft closure. Ann Thorac Surg, 1996, 62(2): 524-525.
7.	Wilcox BR, Jones DR, Frantz EG, et al. Anatomically sound, simplified approach to repair of “complete” atrioventricular septal defect. Ann Thorac Surg, 1997, 64(2):487-494.
8.	Nicholson IA, Nunn GR, Sholler GF, et al. Simplified single patch technique for the repair of atrioventricular septal defect. J Thorac Cardiovasc Surg, 1999, 118(4): 642-646.
9.	Tagliari AP, Teixeira FG, Prates PR, et al. Results of simplified single-patch repair for complete atrioventricular septal defect. Arq Bras Cardiol, 2013, 100(3): 288-293.
10.	Pan G, Song L, Zhou X, et al. Complete atrioventricular septal defect: comparison of modified single-patch technique with two-patch technique in infants. J Card Surg, 2014, 29(2): 251-255.
11.	Backer CL, Stewart RD, Mavroudis C. What is the best technique for repair of complete atrioventricular canal? Semin Thorac Cardio-vasc Surg, 2007, 19(3): 249-57.
12.	莫绪明, 孙剑, 彭卫, 等. 单片下压法矫治122例完全型房室间隔缺损. 中华胸心血管外科杂志, 2014, 30(10): 582-585.
13.	Shi G, Chen H, Hong H, et al. Results of one-and-a-half-patch technique for repair of complete atrioventricular septal defect with a large ventricular component. Eur J Cardiothorac Surg, 2015, 47(3): 520-524.
14.	袁峰, 李晓峰, 郭健, 等. 改良单片法和双片法矫治小婴儿完全性房室通道畸形.中华胸心血管外科杂志, 2013, 29(5): 279-281.
15.	祝忠群, 苏肇伉, 徐志伟, 等. 完全性房室间隔缺损三种手术方法的比较. 中华外科杂志, 2004, 42(10): 634-635.
16.	刘迎龙, 于存涛, 沈向东, 等. 婴幼儿完全性心内膜垫缺损的外科治疗. 中华胸心血管外科杂志, 2005, 21(6): 365-366.
17.	Al Senaidi KS, Ross DB, Rebeyka IM, et al. Comparison of two surgical techniques for complete atrioventricular septal defect repair using two-and three-dimensional echocardiography. Pediatric Cardiology, 2013, 35(3): 393-398.
18.	Ugaki S, Khoo NS, Ross DB, et al. Modified single-patch compared with two-patch repair of complete atrioventricular septal defect. Ann Thoracic Surg, 2014, 97(2): 666-671.
19.	Atz AM, Hawkins JA, Lu M, et al. Surgical management of complete atrioventricular septal defect: Associations with surgical technique, age, and trisomy 21. J Thoracic Cardiovasc Surg, 2011, 141(6): 1371-1379.
20.	Harmandar B, Aydemir NA, Karaci AR, et al. Results for surgical correction of complete atrioventricular septal defect: associations with age, surgical era, and technique. J Card Surg, 2012, 27(6): 745-753.
21.	贾兵, 叶明, 陈张根, 等. 婴幼儿完全性房室间隔缺损的外科治疗. 心肺血管病杂志, 2013, 32(6): 692-694.
22.	Nunn GR. Atrioventricular canal: modified single patch technique. Semin Thorac Cardiovasc Surg, 2007, 10(1): 28-31.
23.	Sivalingam S, Al-Fahmi NA, Kong PK, et al. Early and midterm outcome of complete Atrioventricular Septal Defect (AVSD) in a single institution. Indian J Thoracic Cardiovasc Surg, 2013, 29(4): 223-229.
24.	仇黎生, 郑海, 刘锦纷, 等. 完全性房室间隔缺损的外科治疗. 中华胸心血管外科杂志, 2007, 23(6): 369-371.
25.	赵天力, 胡建国, 杨一峰, 等. 改良单片法纠治完全性房室间隔缺损. 中华胸心血管外科杂志, 2006, 22(4): 265-265.
26.	祝忠群, 苏肇伉, 徐志伟, 等. “简化一片法”治疗完全性房室隔缺损. 中华胸心血管外科杂志, 2003, 19(6): 378-378.
27.	Suzuki T, Bove EL, Devaney EJ, et al. Results of definitive repair of complete atrioventricular septal defect in neonates and infants. Ann Thorac Surg, 2008, 86(2): 596-602.
28.	Deraz S, Ismail M, Deraz S, et al. Single patch technique versus double patch technique in repair of complete atrioventricular septal defect. Egyptian Heart J, 2014, 66(2): 177-182.
29.	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.
30.	Jonas RA, Mora B. Individualized approach to repair of complete atrioventricular canal selective use of the traditional single-patch technique versus the australian technique. J World J Pediatr Con-genit Heart Surg, 2010, 1(1): 78-86.
31.	Litwin SB, Tweddell JS, Mitchell ME, et al. The double patch repair for complete atrioventricularis communis. Semin Thorac Cardio-vasc Surg Pediatr Card Surg Annu, 2007: 21-27.
32.	Bogers AJ, Akkersdijk GP, de Jong PL, et al. Results of primary two-patch repair of complete atrioventricular septal defect. Eur J Cardiothorac Surg, 2000, 18(4): 473-479.
33.	Jeong IS, Lee CH, Lee C, et al. Surgical outcomes of the modified single-patch technique in complete atrioventricular septal defect. Interact Cardiovasc Thorac Surg, 2009, 8(4): 435-438.
34.	Kumar DA, Kumar RS, Rao PN, et al. Complete atrioventricular septal defect repair: Simplified single patch technique. Indian J Thoracic Cardiovasc Surg, 2003, 19(2): 102-107.
35.	Gupta U, Polimenakos AC, Elzein C, et al. Tetralogy of Fallot with atrioventricular septal defect: surgical strategies for repair and midterm outcome of pulmonary valve-sparing approach. Pediatr Cardiol, 2013, 34(4): 861-871.
36.	Monteiro AJ, Canale LS, Rangel I, et al. Surgical treatment of comp-lete atrioventricular septal defect with the two-patch technique: early-to-mid follow-up. Interact Cardiovasc Thorac Surg, 2008, 6(6): 737-740.
37.	Daebritz S, Nido PJD. Surgical management of common atrioven-tricular canal. Prog Pediatr Cardiol, 1999, 10(3): 161-171.
38.	Singh RR, Warren PS, Reece TB. Early repair of complete atrioven-tricular septal defect is safe and effective. Ann Thorac Surg, 2006, 82(5): 1598-1602.
39.	Tumanyan MR, Filaretova OV, Chechneva VV, et al. Repair of complete atrioventricular septal defect in infants with Down synd-rome: outcomes and long-term results. Pediatr Cardiol, 2015, 36(1): 71-75.
40.	Halit V, Oktar GL, Imren VY, et al. Traditional single patch versus the "Australian" technique for repair of complete atrioventri-cular canal defects. Surg Today, 2008, 38(11): 999-1003.

1. 李守军, 高峰, 吴清玉, 等. 完全性房室通道的外科治疗. 中华胸心血管外科杂志, 2005, 12(5): 323-325.
2. Najm HK, Coles JG, Endo M, et al. Complete atrioventricular septal defects: results of repair, risk factors, and freedom from reoperation. Circulation, 1997, 96(9Suppl): 829-835.
3. Samaánek M. Prevalence at birth, "natural" risk and survival with atrioventricular septal defect. Cardiol Young, 1991, 1(1): 285-289.
4. Reddy VM, McElhinney DB, Brook MM. et al. Atrioventricular valve function after single patch repair of complete atrioventricular septal defect in infancy: how early should repair be attempted? J Thorac Cardiovasc Surg, 1998, 115(5): 1032-1040.
5. Trusler GA, Mills NL, Ochsner JL, et al. Correction of Type C comp-lete atrioventricular canal. J Thorac Cardiovasc Surg, 1976, 71(1): 20-28.
6. Alexi-Meskishvili V, Ishino K, Dähnert I, et al. Correction of comp-lete atrioventricular septal defects with the double-patch technique and cleft closure. Ann Thorac Surg, 1996, 62(2): 524-525.
7. Wilcox BR, Jones DR, Frantz EG, et al. Anatomically sound, simplified approach to repair of “complete” atrioventricular septal defect. Ann Thorac Surg, 1997, 64(2):487-494.
8. Nicholson IA, Nunn GR, Sholler GF, et al. Simplified single patch technique for the repair of atrioventricular septal defect. J Thorac Cardiovasc Surg, 1999, 118(4): 642-646.
9. Tagliari AP, Teixeira FG, Prates PR, et al. Results of simplified single-patch repair for complete atrioventricular septal defect. Arq Bras Cardiol, 2013, 100(3): 288-293.
10. Pan G, Song L, Zhou X, et al. Complete atrioventricular septal defect: comparison of modified single-patch technique with two-patch technique in infants. J Card Surg, 2014, 29(2): 251-255.
11. Backer CL, Stewart RD, Mavroudis C. What is the best technique for repair of complete atrioventricular canal? Semin Thorac Cardio-vasc Surg, 2007, 19(3): 249-57.
12. 莫绪明, 孙剑, 彭卫, 等. 单片下压法矫治122例完全型房室间隔缺损. 中华胸心血管外科杂志, 2014, 30(10): 582-585.
13. Shi G, Chen H, Hong H, et al. Results of one-and-a-half-patch technique for repair of complete atrioventricular septal defect with a large ventricular component. Eur J Cardiothorac Surg, 2015, 47(3): 520-524.
14. 袁峰, 李晓峰, 郭健, 等. 改良单片法和双片法矫治小婴儿完全性房室通道畸形.中华胸心血管外科杂志, 2013, 29(5): 279-281.
15. 祝忠群, 苏肇伉, 徐志伟, 等. 完全性房室间隔缺损三种手术方法的比较. 中华外科杂志, 2004, 42(10): 634-635.
16. 刘迎龙, 于存涛, 沈向东, 等. 婴幼儿完全性心内膜垫缺损的外科治疗. 中华胸心血管外科杂志, 2005, 21(6): 365-366.
17. Al Senaidi KS, Ross DB, Rebeyka IM, et al. Comparison of two surgical techniques for complete atrioventricular septal defect repair using two-and three-dimensional echocardiography. Pediatric Cardiology, 2013, 35(3): 393-398.
18. Ugaki S, Khoo NS, Ross DB, et al. Modified single-patch compared with two-patch repair of complete atrioventricular septal defect. Ann Thoracic Surg, 2014, 97(2): 666-671.
19. Atz AM, Hawkins JA, Lu M, et al. Surgical management of complete atrioventricular septal defect: Associations with surgical technique, age, and trisomy 21. J Thoracic Cardiovasc Surg, 2011, 141(6): 1371-1379.
20. Harmandar B, Aydemir NA, Karaci AR, et al. Results for surgical correction of complete atrioventricular septal defect: associations with age, surgical era, and technique. J Card Surg, 2012, 27(6): 745-753.
21. 贾兵, 叶明, 陈张根, 等. 婴幼儿完全性房室间隔缺损的外科治疗. 心肺血管病杂志, 2013, 32(6): 692-694.
22. Nunn GR. Atrioventricular canal: modified single patch technique. Semin Thorac Cardiovasc Surg, 2007, 10(1): 28-31.
23. Sivalingam S, Al-Fahmi NA, Kong PK, et al. Early and midterm outcome of complete Atrioventricular Septal Defect (AVSD) in a single institution. Indian J Thoracic Cardiovasc Surg, 2013, 29(4): 223-229.
24. 仇黎生, 郑海, 刘锦纷, 等. 完全性房室间隔缺损的外科治疗. 中华胸心血管外科杂志, 2007, 23(6): 369-371.
25. 赵天力, 胡建国, 杨一峰, 等. 改良单片法纠治完全性房室间隔缺损. 中华胸心血管外科杂志, 2006, 22(4): 265-265.
26. 祝忠群, 苏肇伉, 徐志伟, 等. “简化一片法”治疗完全性房室隔缺损. 中华胸心血管外科杂志, 2003, 19(6): 378-378.
27. Suzuki T, Bove EL, Devaney EJ, et al. Results of definitive repair of complete atrioventricular septal defect in neonates and infants. Ann Thorac Surg, 2008, 86(2): 596-602.
28. Deraz S, Ismail M, Deraz S, et al. Single patch technique versus double patch technique in repair of complete atrioventricular septal defect. Egyptian Heart J, 2014, 66(2): 177-182.
29. 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.
30. Jonas RA, Mora B. Individualized approach to repair of complete atrioventricular canal selective use of the traditional single-patch technique versus the australian technique. J World J Pediatr Con-genit Heart Surg, 2010, 1(1): 78-86.
31. Litwin SB, Tweddell JS, Mitchell ME, et al. The double patch repair for complete atrioventricularis communis. Semin Thorac Cardio-vasc Surg Pediatr Card Surg Annu, 2007: 21-27.
32. Bogers AJ, Akkersdijk GP, de Jong PL, et al. Results of primary two-patch repair of complete atrioventricular septal defect. Eur J Cardiothorac Surg, 2000, 18(4): 473-479.
33. Jeong IS, Lee CH, Lee C, et al. Surgical outcomes of the modified single-patch technique in complete atrioventricular septal defect. Interact Cardiovasc Thorac Surg, 2009, 8(4): 435-438.
34. Kumar DA, Kumar RS, Rao PN, et al. Complete atrioventricular septal defect repair: Simplified single patch technique. Indian J Thoracic Cardiovasc Surg, 2003, 19(2): 102-107.
35. Gupta U, Polimenakos AC, Elzein C, et al. Tetralogy of Fallot with atrioventricular septal defect: surgical strategies for repair and midterm outcome of pulmonary valve-sparing approach. Pediatr Cardiol, 2013, 34(4): 861-871.
36. Monteiro AJ, Canale LS, Rangel I, et al. Surgical treatment of comp-lete atrioventricular septal defect with the two-patch technique: early-to-mid follow-up. Interact Cardiovasc Thorac Surg, 2008, 6(6): 737-740.
37. Daebritz S, Nido PJD. Surgical management of common atrioven-tricular canal. Prog Pediatr Cardiol, 1999, 10(3): 161-171.
38. Singh RR, Warren PS, Reece TB. Early repair of complete atrioven-tricular septal defect is safe and effective. Ann Thorac Surg, 2006, 82(5): 1598-1602.
39. Tumanyan MR, Filaretova OV, Chechneva VV, et al. Repair of complete atrioventricular septal defect in infants with Down synd-rome: outcomes and long-term results. Pediatr Cardiol, 2015, 36(1): 71-75.
40. Halit V, Oktar GL, Imren VY, et al. Traditional single patch versus the "Australian" technique for repair of complete atrioventri-cular canal defects. Surg Today, 2008, 38(11): 999-1003.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparision of Two Techniques Used in Complete Atrioventricular Septal Defects: A Systematic Review and Meta-analysis

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