Factors associated with residual left atrioventricular valve regurgitation after repair of atrioventricular septal defects

Abstract

Background
Reoperation for atrioventricular valve (AVV) regurgitation after atrioventricular septal defect (AVSD) repair is common, and residual left AVV regurgitation is a contributing factor. This retrospective study investigated the risk factors for residual AVV regurgitation following surgical repair of AVSD and their impact on both short-term and long-term outcomes. We analyzed data from 169 patients who underwent AVSD repair at a tertiary cardiac referral center between July 2010 and August 2023. All patients underwent biventricular repair.


Results
We found that 29% of the patients experienced moderate or severe residual left AVV regurgitation postoperatively. Significant associations were identified between male sex (OR 2.23 (95% CI 1.08–4.62); P = 0.03), moderate preoperative left AVV regurgitation (OR 4.75 (95% CI 1.53–14.76); P = 0.01), and the occurrence of residual left AVV regurgitation. Patients with residual left AVV regurgitation had notably poorer outcomes, including higher rates of complete heart block (27 vs. 10%; P < 0.01), pulmonary artery pressure (median 25 vs. 20 mmHg; P < 0.01), left ventricular dysfunction (22 vs. 3%, P < 0.01), and overall mortality (2.9%); all of them were with residual left AVV regurgitation (5 vs. 0, P < 0.01). Long-term follow-up indicated a marked reduction in freedom from reoperation for those with residual left AVV regurgitation. Replacement. The rates of freedom from reoperation at 1, 3, and 5 years were 99%, 98%, and 96%, respectively, for patients without residual regurgitation and 81%, 75%, and 75%, respectively, for those with residual left AVV regurgitation (log-rank P < 0.01).


Conclusions
Preoperative atrioventricular valve regurgitation was identified as an independent predictor of residual regurgitation. Residual regurgitation was associated with poor hospital outcomes and increased reoperation rates. These findings underscore the importance of addressing preoperative risk factors to optimize surgical outcomes in AVSD repair.