Modified single-patch versus double-patch repair in complete atrioventricular septal defect: a comparative study of surgical and long-term outcomes

Abstract

Aims: Complete atrioventricular septal defect (CAVSD) is a complex congenital cardiac anomaly, accounting for 3–4% of all congenital heart diseases and frequently associated with Trisomy 21. It involves a common atrioventricular valve (AVV) and large septal defects, often necessitating early surgical intervention to prevent irreversible pulmonary vascular disease. While the double-patch technique (DPT) has been widely used for decades, the modified single-patch technique (MSPT) has recently gained popularity due to its technical simplicity and reduced manipulation of the AVV. However, comparative data on the short- and long-term outcomes of these two approaches remain limited. This study aimed to compare the early and long-term clinical results of the MSPT and DPT, focusing on postoperative mortality and AVV regurgitation. Methods: We conducted a retrospective review of 56 patients who underwent complete CAVSD repair between 2009 and 2023 at a single center. Thirty-seven patients (66%) were treated with MSPT, and 19 patients (34%) with DPT. Patient demographics, perioperative data, postoperative complications, mortality, and long-term outcomes were evaluated. The mean follow-up duration among 45 patients was 73.2±4.1 months. Results: The MSPT group had a significantly younger median age (7.5 vs. 14 months; p=0.003) and smaller ventricular septal defect (VSD) diameters (8.2 mm vs. 13.8 mm; p<0.001) than the DPT group. Cardiopulmonary bypass (CPB) and aortic crossclamp (ACC) times were significantly shorter in the MSPT group (p<0.001). Moderate-to-severe early postoperative left AVV (LAVV) regurgitation was more frequent in the DPT group (p=0.016), while postoperative drainage volume was significantly higher in the DPT group as well (p=0.019). Early postoperative mortality occurred in 2 patients (3.5%) overall, and the total mortality for the entire cohort was 11.1%, with no statistically significant difference observed between the MSPT and DPT Reoperation due to progressive LAVV regurgitation occurred in 3 patients (6.6%)—1 in the MSPT and 2 in the DPT group—again without statistical significance. No cases of left ventricular outflow tract obstruction were observed in either group. Conclusion: Our findings suggest that MSPT, with its simplicity and favorable outcomes, may be an effective surgical technique for selected CAVSD patients, particularly those with smaller VSDs. Compared to DPT, it is associated with shorter operative times and a significantly lower rate of early moderate-to-severe LAVV regurgitation, while offering comparable long-term mortality and reoperation rates.

Keywords

• Complete atrioventricular septal defect
• congenital heart disease
• modified single-patch technique
• Trisomy 21

Ethical Statement

The study protocol was approved by the institutional review board of the Anadolu Medical Center, Kocaeli, Turkey (no, ASM-EK-25/292; date, March 19, 2025); and the study was conducted in accordance with the Declaration of Helsinki

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