Left atrioventricular valve durability in atrioventricular septal defects: Impact of systolic blood pressure.

OBJECTIVE

To evaluate the impact of systolic blood pressure (SBP) on the durability of left atrioventricular valve (LAVV) repair in the early postoperative period.

METHODS

Single-center, retrospective review of 88 consecutive patients undergoing atrioventricular septal defect (AVSD) repair over 5 years. Postoperative transesophageal echocardiogram and discharge transthoracic echocardiogram were compared, and patients who experienced deterioration in valve function were identified.

RESULTS

Primary diagnosis was complete AVSD in 63 patients (72%), transitional AVSD in 14 (16%), and partial AVSD in 11 (12%). Overall survival was 98% (n = 86) at a median follow-up of 1.9 years (interquartile range [IQR], 0.6-3.15 years). Patients with a peak SBP >160 mm Hg sustained for as little as 10 seconds had a higher rate of valve deterioration compared to those with a peak SBP <160 mm Hg (70% vs 43%; P = .012), conferring a 3-fold increased risk of valve deterioration (odds ratio, 2.96; 95% confidence interval, 1.16-7.57; P = .023). Incremental increases in peak SBP were linearly associated with valve deterioration starting at a peak SBP >150 mm Hg. SBP >160 mm Hg was identified as an independent predictor of valve deterioration on multivariate logistic regression, while patient weight, gestational age, primary diagnosis, cardiopulmonary bypass time, cross-clamp time, and cleft closure were not predictive of valve deterioration.

CONCLUSIONS

Elevated SBP during the early postoperative period is associated with functional LAVV deterioration. Elevated peak SBP >160 mm Hg was associated with worse LAVV function. Strict control of blood pressure to avoid even transient elevations in SBP during the postoperative period may improve LAVV durability.