Objective: The most frequent cause for reoperation after an index atrioventricular septal defect (AVSD) repair is left atrioventricular valve (LAVV) dysfunction. LAVV stenosis, although less common than regurgitation, may be a more problematic lesion to repair. We sought to identify baseline LAVV anatomic characteristics and outcomes associated with both LAVV reoperation overall, and LAVV stenosis in particular.
Methods: A retrospective review was conducted on patients who underwent a biventricular index AVSD repair between January 1995 and August 2024. All AVSD subtypes were included. Univariate and multivariate Fine-Gray analyses were performed, Kaplan-Meier estimates with log-rank were utilized for survival analysis.
Results: A total of 838 patients underwent an index AVSD, of which 82 underwent at least one LAVV reoperation. Multivariate Fine-Gray analysis demonstrated short chordae, hypoplastic inferior bridging leaflets, double orifice LAVV, repairs for left ventricular outflow tract obstruction and aortic arch repairs were significantly associated with LAVV reoperations in general (p≤ 0.01) while univariate competing risks analysis demonstrated subvalvar malformations were the most significant risk factors for LAVV reoperations for stenosis (p= 0.0001). Six-year replacement-free survival for patients who underwent reoperation for LAVVS and LAVVR was 16.1% and 86.8% respectively.
Conclusion: Patients with subvalvar malformations were at significantly higher risk for LAVV reoperation due to stenosis. Most patients who developed LAVV stenosis ultimately required valve replacement within the first five years after index AVSD repair and had significantly worse actuarial survival than those who only underwent LAVV reoperation for isolated regurgitation.
Keywords: Atrioventricular septal defect; left atrioventricular valve; regurgitation; reoperation; replacement; stenosis.
Copyright © 2025. Published by Elsevier Inc.