Newswise — Boston, MA (May 2, 2021) – A new study, presented today at the AATS 101st Annual Meeting, shows an association between decreased survival at five years and leaving an atrial communication at biventricular repair of unbalanced AVSD after adjusting for other known risk factors. During repair of atrioventricular septal defect (AVSD), surgeons may leave an atrial level shunt when they have concerns about postoperative pulmonary hypertension, a hypoplastic right ventricle (RV), hypoplastic left ventricle (LV), or as part of their routine practice. The study sought to determine factors associated with mortality after biventricular repair of AVSD. 

The study included 581 patients enrolled from 31 Congenital Heart Surgeons’ Society (CHSS) institutions from Jan. 1, 2012 – June 1, 2020. Parametric multiphase hazard analysis was used to identify factors associated with mortality. A random effect model was used to account for possible inter-institutional variability in mortality.

An atrial fenestration was placed during biventricular repair in 23 percent of patients. Overall, five-year survival after repair was 91 percent. The atrial fenestration group had an 83 percent five-year survival compared to 93 percent in the non-fenestrated group.  According to Connor Callahan, the John W. Kirklin/David Ashburn Fellow of the Congenital Heart Surgeons' Society Data Center and University of Toronto, General Surgery Resident at Washington University/Barnes-Jewish Hospital, “Atrial fenestration was associated with reduced long-term survival in our study. As a result of these findings, institutions and surgeons that routinely use fenestration may reevaluate its role in their practice.”

While leaving an atrial communication at biventricular repair of unbalanced AVSD is associated with significantly reduced long-term survival after adjusting for other known risk factors, it is unknown whether this association is causal or related to unmeasured factors, or a combination of both. The impact of fenestration can optimally be derived from a randomized clinical trial in the future.


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Notes for Editors:


“Atrial Fenestration During Atrioventricular Septal Defect Repair Is Associated With Increased Mortality,”


Connor P Callahan, Anusha Jegatheeswaran, David J. Barron, Osami Honjo, Pirooz Eghtesady, David M. Overman, Eugene H Blackstone, Jeevanantham Rajeswaran, Karthik Ramakrishnan, Adil Husain, Jeffrey P. Jacobs, Jennifer S. Nelson, Anastasios Polimenakos, Christopher A. Caldarone, Stephanie M. Fuller, Robert J Dabal, James K. Kirklin, Tharini Paramananthan, Alistair Phillips, William M DeCampli, Brian W McCrindle. The Hospital for Sick Children, Toronto, ON, Canada; St. Louis Children's Hospital, St. Louis, MO; The Children's Heart Clinic, Minneapolis, MN; Cleveland Clinic, Cleveland, OH; Children's National Health System, Washington, DC; Primary Children's Medical Center, Salt Lake City, UT; University of Florida, Gainesville, FL; Nemours Children's Hospital, Orlando, FL; Children's Hospital of Georgia, Augusta, GA; Texas Children's Hospital, Houston, TX; Children's Hospital of Philadelphia, Philadelphia, PA; University of Alabama at Birmingham, Birmingham, AL; Cleveland Clinic Children's, Cleveland, OH; Arnold Palmer Hospital for Children, Orlando, FL


Presented by Connor Callahan, MD, May 2, 2021 at the AATS 101st Annual Meeting.



The American Association for Thoracic Surgery (AATS) is an international organization that encourages, promotes, and stimulates the scientific investigation of cardiothoracic surgery. Founded in 1917 by a respected group of the earliest pioneers in the field, its original mission was to “foster the evolution of an interest in surgery of the Thorax.” Today, the AATS is the premiere association for cardiothoracic surgeons in the world and works to continually enhance the ability of cardiothoracic surgeons to provide the highest quality of patient care. Its more than 1,500 members have a proven record of distinction within the specialty and have made significant contributions to the care and treatment of cardiothoracic disease. Visit to learn more.