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Surgical Treatment and Timing

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CAVSD open-heart surgery has a success rate of over 95% and is typically performed when an infant is 3 to 6 months old. Surgeons close the holes in the heart and reconstruct the common valve into two separate valves, followed by a 1 to 2 week hospital recovery.

Key Takeaways

  • • CAVSD surgery is a highly successful open-heart procedure, with initial survival rates over 95 percent.
  • • The optimal timing for surgery is typically between 3 to 6 months of age to prevent long-term lung damage from pulmonary hypertension.
  • • Surgeons use either a single-patch or double-patch technique to close the heart holes and reconstruct the common valve.
  • • Infants generally spend 1 to 2 weeks recovering in the hospital, beginning in the pediatric intensive care unit.
  • • Children with Down syndrome have excellent surgical outcomes and may have a lower risk of needing future surgeries for leaky valves.

Surgical repair for Complete Atrioventricular Septal Defect (CAVSD) is a standard procedure with a very high success rate—typically well over 95% for survival of the initial repair [1][2]. While the prospect of open-heart surgery is daunting, the goal is to give your child a “complete anatomic repair,” which rebuilds the heart’s internal structure so it can function efficiently [1].

When is the “Right” Time for Surgery?

For most infants with balanced CAVSD, the optimal window for surgery is within the first 3 to 6 months of life [1][3]. Doctors prefer to perform the repair early to prevent long-term damage to the lungs from high blood pressure (pulmonary hypertension) caused by the extra blood flow [4][5].

Surgery may be moved up (sometimes before 3 months of age) if your baby is experiencing severe:

  • Congestive Heart Failure: The heart is unable to pump enough blood to meet the body’s needs [1][3].
  • Failure to Thrive: Your baby is not gaining enough weight despite feeding tubes or fortified formulas, because they are burning too much energy to breathe and circulate blood [1][6].

How the Repair is Done

The surgeon’s primary task is to turn a heart with one large hole and one common valve into a heart with separate chambers and two functioning valves [7]. There are two main ways surgeons achieve this:

  • The Double-Patch Technique: This is a traditional method using two separate patches—one to close the hole in the upper chambers (atria) and one for the hole in the lower chambers (ventricles) [8][9].
  • The Modified Single-Patch Technique: Also known as the “Australian Technique,” this uses one patch to close both holes [10][11]. This method often results in shorter time spent on the heart-lung bypass machine [10].

Both techniques have excellent outcomes, and your surgeon will choose the one that best fits your baby’s specific heart structure [12][9].

A critical part of either surgery is “splitting” the single large common valve into two separate valves: the mitral valve (on the left) and the tricuspid valve (on the right) [7]. The surgeon reconstructs the flaps of the valve to ensure they close tightly and prevent blood from leaking backward (regurgitation) [7][13].

What to Expect in the Hospital

Knowing what your baby will experience can help alleviate the fear of the unknown. While every child’s recovery is unique, a typical hospital stay follows this path:

  1. The Intensive Care Unit (ICU): Immediately after surgery, your baby will go to the Pediatric Cardiac ICU. They will likely still be asleep and connected to a ventilator (breathing machine) for the first day or two.
  2. Tubes and Lines: Your baby will have IV lines for medications, a feeding tube, and chest tubes (small plastic tubes inserted into the chest to drain excess fluid and blood). Seeing your baby like this can be shocking, but these are temporary and closely monitored tools to keep them safe.
  3. Moving to the Step-Down Unit: After a few days, once the breathing tube and chest tubes are removed and your baby is stable, they will move to a regular cardiac ward.
  4. Discharge: The total hospital stay is usually between 1 to 2 weeks. Your baby will go home once they are breathing comfortably on their own, their pain is well managed with oral medications, and they are feeding well enough to gain weight.

Positive Outcomes for Children with Down Syndrome

If your child has Down syndrome, you may be reassured to know that they typically do very well with this surgery [14].

  • Success Rates: Children with Down syndrome have surgical survival rates that are as good as—and sometimes better than—children without the syndrome [14][15].
  • Valve Function: Interestingly, children with Down syndrome are often less likely to need a second surgery for a leaky valve later in life [16][17].

The primary goal of surgery is to improve your baby’s quality of life, allowing them to eat, grow, and play without the heart working overtime [1][18].

Frequently Asked Questions

When is the best time for CAVSD surgery?
For most infants, the optimal window for surgery is between 3 and 6 months of age. Surgery may be performed earlier if the baby is experiencing severe congestive heart failure or is not gaining enough weight.
What happens during CAVSD repair surgery?
The surgeon will use either a single or double-patch technique to close the large hole in the center of the heart. They will also divide the single common valve into two separate, functioning valves to ensure blood flows correctly without leaking.
How long will my baby be in the hospital after AVSD surgery?
A typical hospital stay lasts between 1 and 2 weeks. Your baby will start their recovery in the Pediatric Cardiac ICU with temporary breathing and chest tubes before moving to a regular cardiac ward as they stabilize.
Are CAVSD surgical outcomes different for children with Down syndrome?
Children with Down syndrome typically have excellent surgical survival rates that are as good as or better than children without the syndrome. They are also often less likely to need a second surgery for valve leakage later in life.

Questions for Your Doctor

  • • Which surgical technique do you plan to use (single-patch or double-patch), and why is it the best fit for my baby's anatomy?
  • • What are the specific risks of the surgery, and what is your center's survival rate for this specific procedure?
  • • How does my child's Down syndrome diagnosis change the expected surgical outcome or long-term recovery?
  • • What is the typical length of stay in the hospital after this specific repair, and how long is usually spent in the ICU?
  • • What are the criteria my baby must meet in order to be discharged and go home?

Questions for You

  • • Do I have the support I need (childcare for other children, time off work) for the weeks my baby will be in the hospital?
  • • How am I feeling about the transition from managing symptoms at home to handing my baby over to the surgical team?
  • • Have I prepared myself mentally for seeing my baby with tubes and monitors immediately after surgery?

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References

  1. 1

    Commentary: Repair of complete atrioventricular septal defect: The bar has been set.

    Overman DM

    The Journal of thoracic and cardiovascular surgery 2021; (161(6)):2154-2155 doi:10.1016/j.jtcvs.2020.10.008.

    PMID: 33198972
  2. 2

    Early Correction of Common Atrioventricular Septal Defects: A Single-Center 20-Year Experience.

    Vida VL, Tessari C, Castaldi B, et al.

    The Annals of thoracic surgery 2016; (102(6)):2044-2051 doi:10.1016/j.athoracsur.2016.09.020.

    PMID: 28148455
  3. 3

    Reply: Nonelective correction of patients with complete atrioventricular septal defect failing medical management is a viable option even in very young infants.

    Ramgren JJ

    JTCVS open 2022; (9()):248 doi:10.1016/j.xjon.2021.09.036.

    PMID: 36003439
  4. 4

    Impact of Age and of the Patent Ductus Arteriosus on Pulmonary Hemodynamics in Children with Complete Atrioventricular Septal Defect.

    Rocha LO, Miyague NI, Solarewicz LA, Fernandes-Silva MM

    Pediatric cardiology 2025; (46(8)):2266-2274 doi:10.1007/s00246-024-03636-0.

    PMID: 39223337
  5. 5

    Reply: "Early" has a definition and age matters but program attributes matter more.

    Overman DM

    JTCVS open 2022; (9()):247 doi:10.1016/j.xjon.2021.11.010.

    PMID: 36003428
  6. 6

    Repair of complete atrioventricular septal defect between 2 and 3.5 kilograms: Defining the limits of safe repair.

    Goutallier CS, Buratto E, Schulz A, et al.

    The Journal of thoracic and cardiovascular surgery 2022; (164(4)):1167-1175 doi:10.1016/j.jtcvs.2022.02.031.

    PMID: 35341580
  7. 7

    Electro-vectorcardiographic demonstration of bifascicular block associated with ventricular preexcitation.

    Pérez-Riera AR, Barbosa-Barros R, Daminello-Raimundo R, et al.

    Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc 2019; (24(2)):e12550 doi:10.1111/anec.12550.

    PMID: 29673006
  8. 8

    Is the modified single-patch repair superior to the double-patch repair of complete atrioventricular septal defects?

    Fong LS, Winlaw DS, Orr Y

    Interactive cardiovascular and thoracic surgery 2019; (28(3)):427-431 doi:10.1093/icvts/ivy261.

    PMID: 30239715
  9. 9

    Modified-Single Patch vs Double Patch Repair of Complete Atrioventricular Septal Defects.

    Fong LS, Betts K, Kannekanti R, et al.

    Seminars in thoracic and cardiovascular surgery 2020; (32(1)):108-116 doi:10.1053/j.semtcvs.2019.07.004.

    PMID: 31306766
  10. 10

    Modified Single-Patch versus Two-Patch Repair for Atrioventricular Septal Defect: A Systematic Review and Meta-Analysis.

    Loomba RS, Flores S, Villarreal EG, et al.

    World journal for pediatric & congenital heart surgery 2019; (10(5)):616-623 doi:10.1177/2150135119859882.

    PMID: 31496417
  11. 11

    A review of the Nunn modified single patch technique for atrioventricular septal defect repair.

    Geoffrion TR, Singappuli K, Murala JSK

    Translational pediatrics 2018; (7(2)):91-103 doi:10.21037/tp.2018.02.05.

    PMID: 29770291
  12. 12

    Complete atrioventricular septal defect repair in Australia: Results over 25 years.

    Fong LS, Betts K, Bell D, et al.

    The Journal of thoracic and cardiovascular surgery 2020; (159(3)):1014-1025.e8 doi:10.1016/j.jtcvs.2019.08.005.

    PMID: 31590953
  13. 13

    Repair of the complete atrioventricular septal defect-impact of postoperative moderate or more regurgitation.

    Ozturk M, Tongut A, Sterzbecher V, et al.

    Interdisciplinary cardiovascular and thoracic surgery 2024; (38(4)) doi:10.1093/icvts/ivae053.

    PMID: 38569897
  14. 14

    Outcomes of atrioventricular septal defects with and without down syndrome: analysis of the national inpatient database.

    Aly S, Qattea I, Othman H, et al.

    Cardiology in the young 2024; (34(3)):614-623 doi:10.1017/S1047951123003116.

    PMID: 37667895
  15. 15

    Impact of concomitant complex cardiac anatomy in nonsyndromic patients with complete atrioventricular septal defect.

    Ramgren JJ, Zindovic I, Nozohoor S, et al.

    The Journal of thoracic and cardiovascular surgery 2022; (163(4)):1437-1444 doi:10.1016/j.jtcvs.2021.08.039.

    PMID: 34503843
  16. 16

    The Fate of the Left Atrioventricular Valve After Atrioventricular Septal Defect Repair: Long-Term Outcomes.

    O'Connor M, Stauber CE, Venardos NM, et al.

    Pediatric cardiology 2026; (47(3)):941-949 doi:10.1007/s00246-025-03860-2.

    PMID: 40208292
  17. 17

    Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of complete atrioventricular septal defect.

    Kozak MF, Kozak AC, Marchi CH, et al.

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    PMID: 26313720
  18. 18

    Long-Term Outcome Up To 40 Years after Single Patch Repair of Complete Atrioventricular Septal Defect in Infancy or Childhood.

    Reynen S, Hövels-Gürich HH, Vazquez-Jimenez JF, et al.

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    PMID: 34953470

This page provides educational information about CAVSD surgery and recovery timelines. It is not medical advice. Always discuss your child's specific surgical plan, risks, and recovery with their pediatric cardiologist and surgical team.

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