Abstract
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.