# Cleft closure and other predictors of contemporary outcomes after atrioventricular canal repair in patients with parachute left atrioventricular valve

## TL;DR

This study examines the outcomes of repairing heart defects involving a parachute-shaped left atrioventricular valve and identifies factors that increase the risk of poor results.

## Contribution

The study identifies predictors of adverse outcomes after repairing parachute left atrioventricular valve in patients with atrioventricular septal defect.

## Key findings

- Leaving the cleft completely open during repair is associated with higher risk of poor outcomes.
- Right-dominant AVSDs are at higher risk for LAVV reintervention.
- Sixteen patients (44%) met the composite outcome of death, reintervention, or LAVV dysfunction within 2 years.

## Abstract

Parachute left atrioventricular valve (LAVV) complicates atrioventricular septal defect (AVSD) repair. We evaluate outcomes of AVSD patients with parachute LAVV and identify risk factors for adverse outcomes.

We evaluated all patients undergoing repair of AVSD with parachute LAVV from 2012 to 2021. The primary outcome was a composite of time-to-death, LAVV reintervention and development of greater than or equal to moderate LAVV dysfunction (greater than or equal to moderate LAVV stenosis and/or LAVV regurgitation). Event-free survival for the composite outcome was estimated using Kaplan–Meier methodology and competing risks analysis. Cox proportional hazards regression was used to identify predictors of the primary outcome.

A total of 36 patients were included with a median age at repair of 4 months (interquartile range 2.3–5.5 months). Over a median follow-up of 2.6 years (interquartile range 1.0–5.6 years), 6 (17%) patients underwent LAVV reintervention. All 6 patients who underwent LAVV reintervention had right-dominant AVSD. Sixteen patients (44%) met the composite outcome, and all did so within 2 years of initial repair. Transitional AVSD (versus complete), prior single-ventricle palliation, leaving the cleft completely open and greater than or equal to moderate preoperative LAVV regurgitation were associated with a higher risk of LAVV reintervention in univariate analysis. In multivariate analysis, leaving the cleft completely open was associated with the composite outcome.

Repair of AVSD with parachute LAVV remains a challenge with a significant burden of LAVV reintervention and dysfunction in medium-term follow-up. Unbalanced, right-dominant AVSDs are at higher risk for LAVV reintervention. Leaving the cleft completely open might independently predict poor overall outcomes and should be avoided when possible.

IRB-P00041642

Repair of atrioventricular septal defects (AVSDs) is now routinely performed in infancy with good surgical outcomes and a low risk of reoperation [1–3].