‘Delicate’ and thoughtful approach to AVSD repair shows promise - Children's National

A five-year retrospective study of 63 complete atrioventricular septal defect (AVSD) repairs that applied a patience-filled, consistent and refined approach showed low operative mortality, reduced postoperative length of stay and low rates of readmission or reoperation at Children's National Hospital. The approach, outlined by cardiac surgeon Aybala Tongut, MD and illustrated by medical illustrator Sofia Hanabergh, shows the artistry and technical expertise required for each patient's unique anatomy.

Dr. Tongut writes, "Each repair is a quiet dialogue with the heart. Our role is to listen with our hands."

What it means

"Despite the wealth of knowledge in cardiac surgery, reliable technique guidance for AVSD repair especially one that addresses tactile judgment and intraoperative variability - remains surprisingly scarce," says Dr. Tongut in the article's introduction. This manuscript aims to provide more detailed outlines and images that will allow other surgeons in the field to replicate the approach that applies through "delicate traction and thoughtful positioning."

The procedure is a two-patch repair strategy emphasizing tactile feedback, valve-centric technique and "surgical humility."

Since 2020, Children's National cardiac surgeons performed 63 two-patch repairs. Operative mortality was 1.59%. Median postoperative length of stay among discharged patients was 10 days. Readmissions occurred in 12.7%, and reoperations in 6.3% of patients.

These outcomes show remarkable consistency for a procedure that is known for its inherently variable nature.

Children's National leads the way

Cardiac surgeons at Children's National are leaders in the field and constantly refining new approaches to improve outcomes for children with congenital heart disease. In addition to creating new approaches or perfecting existing ones, the team aims to disseminate evidence-based techniques as widely as possible so that every child with AVSD has the best possible chance to not only survive their congenital heart defect, but also potentially avoid additional procedures for as long as possible.

For AVSD, physicians and families should consider both short-term outcomes, as reflected in Dr. Tongut's manuscript, but also be aware of the long-term outcomes for these repairs. Children's National is one of the only children's hospitals in the U.S. to publish long-term outcomes for some of the most common cardiovascular surgeries performed at the institution.

Read the article, A Surgeon's Reflection on the Refined Two-Patch Technique for Complete Atrioventricular Septal Defect Repair, in the journal Operative Techniques in Thoracic and Cardiovascular Surgery.