One-and-a-half-patch versus modified single-patch technique for repair of complete atrioventricular septal defect: A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LV Jingjing , SHI Guocheng , LIU Wei , ZHU Zhongqun , LU Yanan , ZHANG Haibo ,  CHEN Huiwen

Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Heart Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, P.R.China;

Corresponding author：

CHEN Huiwen, Email: hwhwc@hotmail.com

Keywords：

Complete atrioventricular septal defect; modified single-patch technique; one-and-a-half-patch technique; atrioventricular valve regurgitation; reoperation rate

DOI：

10.7507/1007-4848.201608017

Video：

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Objective To compare the postoperative outcomes of modified single-patch technique and one-and-a-half-patch technique for complete atrioventricular septal defect (CAVSD) with a large ventricular component (>1 cm). Methods We retrospectively reviewed clinical data of 79 CAVSD patients with a large ventricular component (>1 cm) in Shanghai Children's Medical Center from January 2005 through January 2016. There were 37 males, 42 females with a median age of 8 months (range, 1.5 months to 10.2 years). Among the patients, 45 patients (20 males, 25 females) with a median age of 6 months(range, 1.5 months to 10.2 years) received modified single patch technique and 34 patients (17 males, 17 females) with a median age of 5.3 months (range, 2.5 months to 8.3 years) underwent one-and-a-half-patch (1.5-patch) technique. All the patients complicated with complex malformation such as double outlet of right ventricular, single ventricle, and transposition of great arteries were excluded. Results The mortality and reoperation rate in modified single-patch group were higher than those of the one-and-a-half-patch group. There were 2 postoperative early deaths in the modified single-patch group (4.4%). Among them, one patient died of postoperative valvular regurgitation and heart pump failure. The other one died of respiratory failure caused by severe pneumonia. There were 3 reoperations. Two patients performed valve plastic surgery because of valve regurgitation and one patient because of residual ventricular septal defect. There was no death and reoperation in the one-and-a-half-patch technique group. No left ventricular outflow tract obstruction and atrioventricular block in both groups were developed. Conclusion The 1.5-patch technique is an attractive clinical option in CAVSD patients with a large ventricular component.

Citation： LV Jingjing, SHI Guocheng, LIU Wei, ZHU Zhongqun, LU Yanan, ZHANG Haibo, CHEN Huiwen. One-and-a-half-patch versus modified single-patch technique for repair of complete atrioventricular septal defect: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(5): 350-354. doi: 10.7507/1007-4848.201608017 Copy

1.	Anderson RH, Wessels A, Vettukattil JJ. Morphology and morphogenesis of atrioventricular septal defect with common atrioventricular junction. World J Pediatr Congenit Heart Surg, 2010, 1(1): 59-67.
2.	Backer CL, Stewart RD, Bailliard F, et al. Complete atrioventricular canal: comparison of modified single-patch technique with two-patch technique. Ann Thorac Surg, 2007, 84(6): 2038-2046.
3.	Ugaki S, Khoo NS, Ross DB, et al. Modified single-patch compared with two-patch repair of complete atrioventricular septal defect. Ann Thorac Surg, 2014, 97(2): 666-671.
4.	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.
5.	Yildirim O, Avsar M, Ozyuksel A, et al. Modified single versus double-patch technique for the repair of complete atrioventricular septal defect. J Card Surg, 2015, 30(7): 595-600.
6.	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.
7.	Jeong IS, Lee CH, Lee C, et al. Surgical outcomes of the modified single-patch technique in complete atrioventricular septal defect. Inter Cardiovasc Thorac Surg, 2009, 8(4): 435-438.
8.	Lacour-Gayet F, Campbell DN, Mitchell M, et al. Surgical repair of atrioventricular septal defect with common atrioventricular valve in early infancy. Cardiol Young, 2006, 16 Suppl 3: 52-58.
9.	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): 487-4934.
10.	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.
11.	Nunn GR. Atrioventricular canal: modified single patch technique. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2007: 28-31.
12.	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.
13.	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, 2014, 35(3): 393-398.
14.	Ten Harkel AD, Cromme-Dijkhuis AH, Heinerman BC, et al. Development of left atrioventricular valve regurgitation after correction of atrioventricular septal defect. Ann Thorac Surg, 2005, 79(2): 607-612.
15.	丁芳宝, 梅举, 鲍春荣, 等. 房室间隔缺损矫治术后左侧房室瓣反流的外科治疗. 中国胸心血管外科临床杂志, 2011, 18(4): 317-320.
16.	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.
17.	Adachi I, Ho SY, McCarthy KP, et al. Ventricular scoop in atrioventricular septal defect: relevance to simplified single-patch method. Ann Thorac Surg, 2009, 87(1): 198-203.
18.	吴永兵, 徐建军, 李勇, 等. 改良单片法治疗完全性房室隔缺损. 山东医药, 2008, (39): 58-59.
19.	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 Cardio-thorac Surg, 2015, 47(3): 520-524.
20.	Stulak JM, Burkhart HM, Dearani JA, et al. Reoperations after initial repair of complete atrioventricular septal defect. Ann Thorac Surg, 2009, 87(6): 1872-1878.

1. Anderson RH, Wessels A, Vettukattil JJ. Morphology and morphogenesis of atrioventricular septal defect with common atrioventricular junction. World J Pediatr Congenit Heart Surg, 2010, 1(1): 59-67.
2. Backer CL, Stewart RD, Bailliard F, et al. Complete atrioventricular canal: comparison of modified single-patch technique with two-patch technique. Ann Thorac Surg, 2007, 84(6): 2038-2046.
3. Ugaki S, Khoo NS, Ross DB, et al. Modified single-patch compared with two-patch repair of complete atrioventricular septal defect. Ann Thorac Surg, 2014, 97(2): 666-671.
4. 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.
5. Yildirim O, Avsar M, Ozyuksel A, et al. Modified single versus double-patch technique for the repair of complete atrioventricular septal defect. J Card Surg, 2015, 30(7): 595-600.
6. 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.
7. Jeong IS, Lee CH, Lee C, et al. Surgical outcomes of the modified single-patch technique in complete atrioventricular septal defect. Inter Cardiovasc Thorac Surg, 2009, 8(4): 435-438.
8. Lacour-Gayet F, Campbell DN, Mitchell M, et al. Surgical repair of atrioventricular septal defect with common atrioventricular valve in early infancy. Cardiol Young, 2006, 16 Suppl 3: 52-58.
9. 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): 487-4934.
10. 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.
11. Nunn GR. Atrioventricular canal: modified single patch technique. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2007: 28-31.
12. 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.
13. 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, 2014, 35(3): 393-398.
14. Ten Harkel AD, Cromme-Dijkhuis AH, Heinerman BC, et al. Development of left atrioventricular valve regurgitation after correction of atrioventricular septal defect. Ann Thorac Surg, 2005, 79(2): 607-612.
15. 丁芳宝, 梅举, 鲍春荣, 等. 房室间隔缺损矫治术后左侧房室瓣反流的外科治疗. 中国胸心血管外科临床杂志, 2011, 18(4): 317-320.
16. 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.
17. Adachi I, Ho SY, McCarthy KP, et al. Ventricular scoop in atrioventricular septal defect: relevance to simplified single-patch method. Ann Thorac Surg, 2009, 87(1): 198-203.
18. 吴永兵, 徐建军, 李勇, 等. 改良单片法治疗完全性房室隔缺损. 山东医药, 2008, (39): 58-59.
19. 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 Cardio-thorac Surg, 2015, 47(3): 520-524.
20. Stulak JM, Burkhart HM, Dearani JA, et al. Reoperations after initial repair of complete atrioventricular septal defect. Ann Thorac Surg, 2009, 87(6): 1872-1878.

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One-and-a-half-patch versus modified single-patch technique for repair of complete atrioventricular septal defect: A case control study

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