Objective
To compare the postoperative outcomes of modified single-patch technique and one-and-a-half-patch technique for complete atrioventricular septal defect (CAVSD) with a large ventricular component (>1 cm).
Methods
We retrospectively reviewed clinical data of 79 CAVSD patients with a large ventricular component (>1 cm) in Shanghai Children's Medical Center from January 2005 through January 2016. There were 37 males, 42 females with a median age of 8 months (range, 1.5 months to 10.2 years). Among the patients, 45 patients (20 males, 25 females) with a median age of 6 months(range, 1.5 months to 10.2 years) received modified single patch technique and 34 patients (17 males, 17 females) with a median age of 5.3 months (range, 2.5 months to 8.3 years) underwent one-and-a-half-patch (1.5-patch) technique. All the patients complicated with complex malformation such as double outlet of right ventricular, single ventricle, and transposition of great arteries were excluded.
Results
The mortality and reoperation rate in modified single-patch group were higher than those of the one-and-a-half-patch group. There were 2 postoperative early deaths in the modified single-patch group (4.4%). Among them, one patient died of postoperative valvular regurgitation and heart pump failure. The other one died of respiratory failure caused by severe pneumonia. There were 3 reoperations. Two patients performed valve plastic surgery because of valve regurgitation and one patient because of residual ventricular septal defect. There was no death and reoperation in the one-and-a-half-patch technique group. No left ventricular outflow tract obstruction and atrioventricular block in both groups were developed.
Conclusion
The 1.5-patch technique is an attractive clinical option in CAVSD patients with a large ventricular component.
ObjectiveTo summarize the clinical outcomes and experience of surgical treatment for patients with complete atrioventricular septal defect (CAVSD) above the optimal age for surgery.MethodsWe retrospectively reviewed clinical data of 163 simple type CAVSD patients less than 7 years who underwent operations in Fuwai Hospital from 2002 to 2013. The patients were divided into a normal group (n=84, including 37 males and 16 females with an average age of 7.6±2.7 months) and an over-age group (n=79, including 30 males and 49 females with an average age of 34.6±19.6 months) according to whether the age was more than 1 year.ResultsThe average aortic cross clamp time (88.3±24.4 min vs. 106.1±35.4 min, P<0.001) and cardiopulmonary bypass time (123.6±31.1 min vs. 142.6±47.1 min, P=0.003) were statistically different between the two groups. During the follow-up period (the normal group 53.3±43.9 months, the over-age group 57.2±48.2 months), there was no statistical difference in all-cause mortality (10.7% vs. 8.9%, P=0.691), the incidence of moderate or severe left atrioventricular valve regurgitation (16.7% vs. 21.5%, P=0.430) and reintervention rate (3.6% vs. 0.0%, P=0.266) between the two groups. No left ventricular outflow tract obstruction and complete atrioventricular block occurred in both groups.ConclusionFor CAVSD children above the optimal age, rational surgical treatments can also achieve satisfying results.
ObjectiveTo systematically compare the incidence, microbiological profile, and outcomes of infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR). MethodsA systematic literature search was conducted in the CNKI, Wanfang, VIP, SinoMed, PubMed, the Cochrane Library, Embase, and Web of Science databases for relevant studies published from their inception to August 2025. Two reviewers independently screened the literature, extracted data, and assessed the quality of the included studies. The quality of cohort studies was evaluated using the modified Newcastle-Ottawa Scale (NOS), and randomized controlled trials (RCTs) were assessed using the Cochrane Risk of Bias tool 2 (RoB 2). A meta-analysis was performed using Stata 19.0. ResultsA total of 12 cohort studies and 1 RCT, encompassing over 200 000 patients, were included. The modified NOS scores for all cohort studies were ≥7 points, and the RCT was rated as having a low overall risk of bias. The overall incidence of IE was significantly lower after TAVR than that after SAVR [RR=0.73, 95%CI (0.59, 0.90), P<0.01]. However, early IE (within 12 months) occurred more frequently following TAVR, though the difference was not statistically significant [RR=1.23, 95%CI (0.87, 1.75), P=0.24]. Reoperation for IE was markedly less common in the TAVR group [RR=0.31, 95%CI (0.20, 0.47), P<0.01]. There were no significant differences in in-hospital mortality or 1-year mortality between the two groups. Regarding the microbiological profile, no significant differences were observed in the distribution of Staphylococcus aureus, coagulase-negative staphylococci, Streptococcus spp., and Enterococcus spp. (P>0.01). ConclusionTAVR is associated with a lower overall risk of IE but a higher risk of early IE compared to SAVR. Although reoperation is less common in TAVR patients, mortality rates are comparable. The microbiological etiology is consistent between procedures.
