Complete Atrioventricular Septal Defect: Comparison of One-Stage Primary Repair With Two-Stage Surgical Strategy

Background: Complete Atrioventricular Septal Defect (CAVSD) is a congenital heart disease treated by surgical repair. There are two strategies for surgery: 1) Primary re- pair at lower ages (one-stage repair). 2) PA banding in lower age and then complete repair after normalization of PAP (Two-stage repair).The purpose of this study was comparison of mortality rate and short term complications of these two strategies. Patients and Methods: This Cohort study covered 90 patients by CAVSD from a sin- gle center that underwent surgical repair from September, 2005 to October 2010. Forty seven patients operated by one-stage repair and 43 patients by two-stage method. Pa- tients were compared based on preoperative data (age, sex, weight, Down’s syndrome, Pulmonary Artery Pressure”PAP” and Preoperative EF ) intraoperative data (data of Pulmonary Artery “PA” banding, CPB time and aortic cross clamp time) post opera- tive data (post op EF, residual septal defects, residual AV valve regurgitation, ICU stay time and tracheal intubation time) short term complications (Pulmonary complications, bleeding, CHB) and hospital mortality rate. Results: There were no significant differences among two groups concerning age, sex, weight, PAP and Preoperative EF. Failure rate of PA banding was 9.4% in two-stage group.CPB time and aortic cross clamp time in one-stage repair were significantly lower than two-stage repair (P=0, P=0.002). ICU stay and tracheal intubation time in one-stage repair were significantly lower than two-stage repair (P=0, P=0).There were no significant differences among the two groups concerning post operative EF, and residual septal defects. Severe TR was higher in two-stage repair group (P=0.016). Pulmonary complications were lower in one-stage repair group.The. hospital mortality rate in one-stage repair was 6.4% and in two-stage repair was 16.3% (P=0.136). The risk factors for mortality were increased CPB time and aortic cross clamp time. Conclusions: This study demonstrated that one-stage primary repair of CAVSD is a safe method with lower mortality rate and short term complications than two-stage repair and it can be considered as the preferable strategy in CAVSD repair in lower ages.