http://wendykeithdesigns.co.uk/?p=415 The Journal of Thoracic and Cardiovascular Surgery
Volume 161, Issue 5, P1594-1601, MAY 01, 2021
o que fazer no termino do namoro Edward Buratto, MBBS, PhD, Thomas Hu, MD, Adrienne Lui, MD, Damien M. Wu, BBiomed, Yves d’Udekem, MD, PhD, FRACS, Christian P. Brizard, MD, Igor E. Konstantinov, MD, PhD, FRACS
Dal'negorsk Complete atrioventricular septal defect (cAVSD) repair is usually performed between 3 and 6 months of age. However, some children present with early heart failure requiring intervention. It is unclear whether primary complete repair or initial pulmonary artery banding (PAB) provides better outcomes.
http://fortemglobal.com/glan-yr-afon-buy-to-let-nursing-home-opportunity-up-to-10pc-net-returns-pa All patients (n = 194) who underwent surgery for cAVSD younger than 3 months of age between 1990 and 2019 were included. Propensity score matching was performed on risk factors for mortality.
Primary complete repair was performed in 77.8% (151/194), whereas PAB was performed in 22.2% (43/194). Children who had PAB were younger (P < .01), had lower weight (P < .001), and less trisomy 21 (P = .04). Interstage mortality for PAB was 18.6% (8/43), whereas early mortality for primary repair was 3.3% (5/151). Survival at 20 years was 92.0% (95% confidence interval [CI], 85.6%-95.7%) for primary repair and 63.2% (95% CI, 42.5%-78.1%) for PAB (P < .001). There was no difference in left atrioventricular valve (LAVV) reoperation rates (P = .94). Propensity score matching produced 2 well-matched groups. Survival at 20 years was 94.2% (95% CI, 85.1%-98.8%) for primary repair, and 58.4% (95% CI, 33.5%-76.7%) for PAB (P = .001). There was no difference in LAVV reoperation rates (P = .71). Neonatal repair was achieved with no early deaths and 100% survival at 10 years.
In children younger than 3 months of age, complete repair of cAVSD is associated with better survival than PAB. Both strategies have similar rates of LAVV reoperation. Neonatal repair of cAVSD can be achieved with excellent results. Primary repair of cAVSD should be the preferred strategy in children younger than 3 months of age.
Repair of complete atrioventricular septal defects (cAVSD) is usually performed between 3 and 6 months of age. However, some children present early with heart failure or failure to thrive, beside optimized medical management. For those patients two surgical options exist: early repair or pulmonary artery banding (PAB). Decision making in those cases is not always a simple process.
Buratto et at published in their article “Early repair of complete atrioventricular septal defect has better survival than staged repair after pulmonary artery banding: A propensity score-matched study” their outcomes on 193 patients, younger than three months of age, undergoing primary early repair of cAVSD (77.8 %) or PAB (22.2 %). Main message is that strategy for early repair has better outcomes than PAB. Although, there was no significant difference in mortality between primary complete repair (3.3 %) and complete repair after initial PAB (2.9 %) a high interstage mortality with 18.6 % in the PAB group and the need for reoperation for adjustment of the PAB in 7 % of patients emphasize their results. Both strategies had similar rates of left atrioventricular valve reoperations.
Although promising results of this study, other studies reported variable results between primary repair and PAB. Hence, the decision for the best initial operation remains on individual patient, surgical and institutional factors. Is the surgical team familiar with early or particular neonatal cAVSD repair, including surgical technique, perioperative anesthesiologic, cardio-pulmonary bypass and postoperative intensive care management? Especially in resource limited settings these questions may uprise, however, the risk of loosing patient’s follow-up during interstage need to be taken into consideration.