Complete atrioventricular septal defect, Australian repair: Technique and long-term results

BackgroundSurgical repair of complete atrioventricular septal defect (CAVSD) has evolved substantially, with early mortality markedly reduced over the past decades. However, achieving durable left atrioventricular valve (LAVV) competence and preserving left ventricular outflow tract (LVOT) geometry remain critical determinants of long-term success.MethodsThis review summarizes the anatomical principles, operative details, and clinical outcomes of the Nunn-modified single-patch ("Australian") technique for CAVSD repair.ResultsThe Australian technique-characterized by direct approximation of bridging leaflets to the septal crest without a ventricular patch-demonstrates superior preservation of LVOT architecture and promotes symmetrical LAVV coaptation. Contemporary series report >90% freedom from LAVV reoperation and >97% freedom from LVOT obstruction at 10-15 years, outperforming traditional repairs in multiple institutional and multicenter cohorts. These advantages are consistent across a wide spectrum of ventricular septal defect sizes and patient ages, provided anatomical prerequisites are met.ConclusionsBy minimizing prosthetic material and restoring native leaflet geometry, the Australian Repair achieves excellent long-term valve competence and reoperation-free survival. It should be considered a first-line option in appropriately selected CAVSD patients, particularly where durable LAVV function and LVOT integrity are paramount.