Surgery of atrioventricular canal defects

Atrioventricular canal defects comprise a spectrum of lesions from ostium primum plus mitral cleft to complete AV canal (CAVC). The main feature is the absence of the AV septum. This defect affects the attachments of the septal leaflets of the AV valves and there may be a common valve with five to six leaflets in the CAVC, or two AV valves each with three leaflets and a cleft as in the partial AVC. Surgical technique. CAVC has been repaired since the beginning of the open heart surgery. Maloney, in 1962, developed the single patch repair with division of the bridging leaflets that were reattached to the patch. Trusler, in 1975, repaired the leaflet with two patches: one dacron patch to close the VSD and one pericardial patch to close the ostium primum. Wilcox and Nunn, in the nineties, reported the modified single-patch repair: they closed the VSD with interrupted stitches and the ostium primum with a pericardial patch. At the Hospital de Cruces we have developed our no-patch technique: both defects, the VSD and the ostium primum, are sutured primarily with two suture lines. Results. In the last decade, thanks to the policy of surgical repair at an early age, below 6 months of age, hospital mortality has decreased to 3%. The modified single-patch and the no-patch techniques shorten surgical times and allow for a reduction in the need for reoperation, especially for valvular regurgitation. These techniques are simple, safe and reproducible.