SURGICAL SPECIALITY
Introducing a Novel Surgical Technique for Complete Atrioventricular Septal Defect V-Shaped double-layer patch technique This article recommends a novel surgical technique for the treatment of complete atrioventricular septal defect (CAVSD): V-shaped double-layer patch technique. Since 2011, V-shaped double-layer patch technique applied for all CAVSD in our centre which had a satisfactory survival rate and reoperation-free rate during follow-up. Shanquan Sun, Chief, Cardiac Center of Guangdong Women and Children Hospital
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urrently popular surgical techniques for complete atrioventricular septal defect (CAVSD) are mainly ‘two-patch technique’ and ‘modified single-patch technique’. The discussion on which surgical strategy to use (two-patch versus modified single-patch technique) has continued for more than 20 years. As pointed out by Prof. Carl L. Backer, an internationally renowned authoritative expert in congenital heart surgery, cardiac surgeons have always been troubled by reoperation due to postoperative left atrioventricular valve regurgitation. Here in our centre, we applied a novel surgical technique ‘V-shaped double-layer patch technique’. It is a functional surgical technique, in which the left atrioventricular valve (LAVV) was protected by maintaining its original shape and position, avoiding being pulled by the patch tension. The
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A SI A N H O S P I T A L & H EA LT HCA R E M A N AGE M E N T
follow-up (the longest 10 years, and the median 5.1 years) results have exhibited excellent performance of this technique. Designing of the V-shaped doublelayer patch technique
The surgical technique for CAVSD should be designed to have anatomic advantages and to be more consistent with the principle of haemodynamic, so as to reduce the postoperative complications and improve prognosis. The V-shaped double-layer patch technique procedures proved to reduce the reoperation rate. Moreover, it is simple and takes no more operating time than other techniques. We noticed some something interesting: (1) severe AV regurgitation and LV outflow tract stenosis were less common in partial atrioventricular septal defect (PAVSD), and the long-term prognosis was much better than CAVSD.
IS S UE - 57, 2022
(2) Some CAVSD cases had no or only mild AV regurgitation before operation, and the common atrioventricular valve (AV) regurgitation may be characterised by progressive aggravation. (3) We consecutively observed 111 cases of fetal CAVSD echocardiography and found that 94 per cent had no or mild AV valve regurgitation (56 cases without and 48 cases with mild), and only 1 case (0.9 per cent) had severe AV valve regurgitation. Therefore, we consider that in spite of the congenital defects of the AV valve and subvalvular structure of CAVSD, most of them still have a certain haemodynamic structural rationality, and their insufficiency is the result of long-term volume overload. Therefore, it is critical to maintain the original shape and position of the AV and its subvalvular structures for CAVSD patients. Both the classical single-patch and two-patch techniques change the
