Research Article

Comparison of Outcomes of Repair of Complete Atrioventricular Canal Defects before and After 3 Months of Age: A Meta-Analysis

Authors: Awori Mark, Awori Jonathan, Mwachanya Edmond, Awori Isaiah.

DOI: 10.33425/2993-6799.1024

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Abstract

Objectives: It is generally accepted that the ideal age for repair of a complete atrioventricular canal defect (CAVCD) is between 3 to 4 months of age. Patients presenting at younger than 3 months of age, with heart failure despite optimal medical therapy, are generally offered repair too. However, there remains a concern that the outcomes are inferior to repair in patients older than 3 months of age. We aimed to determine if repair before 3 months of age results in inferior outcomes to repair after 3 months of age.

Method: Google Scholar and PUBMED were searched between January 1st 2000 and February 10th 2025. A meta-analysis was conducted after pragmatically minimising patient and method heterogeneity: operative mortality and a composite outcome of ‘more than’ moderate post-operative left atrioventricular valve (LAVV) regurgitation or re-operation for LAVV regurgitation were analysed.

Results: Four studies representing 2741 patients were included for the operative mortality analysis: 405 were 3 months old or less; 2336 were older than 3 months. The operative mortalities were 7.9% and 2.0% for repair at less than 3 months of age and more than 3 months of age respectively. Odds Ratio for operative mortality at a younger age was 4.63 (2.93; 7.31). Three studies representing 285 patients were included for the LAVV outcome analysis: 71 were 3 months old or less; 214 were older than 3 months. Odds ratio for ‘more than’ moderate LAVV regurgitation or re-operation for LAVV regurgitation after repair at a younger age was 1.78 (0.83; 3.78).

Conclusions: There was a significantly greater operative mortality in patients repaired prior to 3 months of age; however, the quality of LAVV function was not significantly different.

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