Peri-operative outcomes of patients undergoing Atrio- Ventricular Septal Defect repair at a new tertiary/quaternary children’s hospital in Johannesburg

Abstract

Background: Atrioventricular septal defect (AVSD) is a common cardiac malformation, representing about 7% of congenital heart diseases and frequently associated with Down syndrome (DS). There is limited South African literature on the perioperative management of this condition. Aim and objectives: This study aimed to identify perioperative factors affecting AVSD repair outcomes, assess patient outcomes, and evaluate repair success at a new center in a low/middle-income country. Methods: This was a retrospective, descriptive record review that included 41 patients with a confirmed diagnosis of AVSD, who underwent corrective surgery over a four-year period. Results: Complete AVSD (CAVSD) was found in 26/41 (63.4%) patients, primum atrial septal defect in 11/41 (26.8%), and inlet ventricular septal defect in 4/41 (9.8%). The median age at diagnosis was five months (IQR 2-13), and at repair was 22 months (IQR 10-30). The overall mortality rate was 7.3%. Patients with CAVSD had longer cardiopulmonary bypass times (median 155 mins, IQR 126-223), cross-clamp times (median 118 mins, IQR 89-174), and ICU stays (median 7 days, IQR 4-12), compared to those with a partial AVSD. Patients with DS had longer ICU stays (median 8.5 days, IQR 4-14) and ventilation times (median 5 days, IQR 2-9.5), compared to those without DS. Post-operatively, 12/41 (29%) patients experienced a pulmonary hypertensive crisis. Conclusion: This study found that CAVSD was the most prevalent type of AVSD and was frequently associated with DS. Operative repair was performed relatively late, particularly in cases of CAVSD. Although mortality rates were similar to other studies, post-operative morbidity was higher, especially in CAVSD and DS. These findings highlight the need for earlier AVSD diagnosis and repair to reduce complications and improve long-term outcomes in these patients.