Central Patch Technique for Repair of Complete Atrioventricular Septal Defects
The central patch technique is an alternative to other accepted techniques for the complete repair of atrioventricular septal defects (ASD). This technique is particularly suited for patients with large Rastelli A defects, as it allows for excellent exposure of the ventricular crest, while maintaining the physiologic height of the atrioventricular (AV) valve tissue above the ventricular crest. Exposure of the ventricular crest is improved versus the two patch technique. AV valve tissue is not pulled away from the coaptation zones, as can occur with the traditional and modified single patch techniques. The central patch is performed by attaching the superior and inferior bridging leaflets on either side of the midline. The AV valve tissue is divided above the ventricular crest, creating an oval-shaped defect in the AV valve tissue. The AV valve tissue is augmented with a patch. Ventricular septal defect sutures are passed through the midline of the central patch and then through the rim of the ASD patch. The remainder of the repair is performed in a similar way to a modified single patch. The central patch repair has been performed in 23 patients over six years without early or late mortality, or the need for reoperation. Longer-term follow-up will be necessary to assess the durability of this repair.
Douglas WI, Doshi U. A novel technique for repair of complete atrioventricular canal defect: The central patch technique. World J Pediatr Congenit Heart Surg. 2014 Jun;5(3):434-439.