Modified single-patch repair comparable to two-patch technique in infants with AVSD

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1. The modified single-patch technique resulted in shorter aortic cross-clamp and bypass times when compared to the two-patch technique.    

2. The modified single-patch technique may reduce postoperative mortality. 

Evidence Rating Level: 2 (Good)            

Study Rundown: The management of complete atrioventricular septal defect (CAVSD) can be accomplished using a single patch or two patches. In the former technique, one patch is used to cover both the atrial and ventricular defects, but division of the common AV valve is required. In the latter, one patch is used for each defect and AV valve division is unnecessary. In the modified single-patch method, the patch does not cover the VSD as it is repaired directly. This study set out to compare the modified single and two-patch techniques, assessing both usefulness and post-operative outcomes. The selection of one or two-patch was left entirely to the discretion of the surgeon. The results showed overall higher mortality, though not significant, in the two-patch group during the follow up period. Three patients died in the two-patch group. While in the modified single-patch group one patient died of pneumonia. The aortic cross-clamp and cardiopulmonary bypass times were significantly shorter in the modified single-patch group. These findings suggest that the modified single-patch technique is safe and reproducible in most cases of AVSD. The study is limited by its retrospective design. Furthermore, there were significantly more infants with Down syndrome in the two-patch group.

Click to read the study in Annals of Surgery

Relevant Reading: Modified single-patch technique: repairing complete atrioventricular septal defect

In-Depth [retrospective study]: This study compared the postoperative outcomes in infants with AVSD who underwent either two-patch or modified single-patch interventions. The study included 98 patients who received primary repair of AVSD. 52 received the two-patch technique, while 46 received the modified single-patch. The aortic cross-clamp time was significantly shorter in the modified single-patch technique when compared to the two-patch technique (70.56±21.05 minutes, 83.76±22.74, p = .004). The CPB time was significantly shorter in the modified single-patch technique (95.02±19.73 minutes, 109.9±34.07, p = .011). There was one in-hospital death in both the groups. With regard to later mortality, there were three deaths in the two-patch group upon complete follow up and only one in the modified single-patch group.

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