Rethinking timing: Outcomes of late versus early surgical repair of complete atrioventricular septal defect in a resource-limited setting.

OBJECTIVE

Complete atrioventricular septal defect (CAVSD) repair is ideally performed within the first 6 months of life; however, in resource-limited settings, access barriers often delay surgery We compared outcomes between early (<6 months) and late (≥6 months) surgical repair at a single reference center in Colombia.

METHODS

A retrospective cohort of 111 consecutive patients (2012-2022) undergoing primary CAVSD repair was analyzed. Patients were divided into early (n = 22) and late (n = 89) groups. Preoperative, intraoperative, and postoperative variables-including operative mortality, survival, and freedom from left atrioventricular valve (LAVV) reintervention-were compared using χ2, Mann-Whitney U, and Kaplan-Meier analyses.

RESULTS

Median age at surgery was 4.9 months (interquartile range, 4.5-5.4) for early versus 8.5 months (interquartile range, 7.2-14.3) for late repair. Trisomy 21 was present in 83.8%. The early group had greater preoperative oxygen saturation (P = .004), less prevalent moderate/severe pulmonary hypertension (P = .013), and less LAVV regurgitation (4.5% vs 43.9%, P = .003). Operative mortality was 4.5% overall (0% early vs 5.6% late, P = .58). The early group had longer intensive care unit (median 8 vs 6 days, P = .012) and hospital stays (median 21 vs 13 days, P = .006). Medium-term survival and freedom from LAVV reintervention were comparable (log-rank P > .05).

CONCLUSIONS

In this cohort, later CAVSD repair yielded operative mortality and medium-term outcomes comparable with early repair despite less-favorable preoperative profiles. These findings may support flexible surgical timing in resource-limited settings with robust perioperative care and follow-up.