Association of postoperative haemodynamic parameters with progression of left atrioventricular regurgitation in infants: leveraging high-fidelity data: a hypothesis-generating study

BACKGROUND: The success of an atrioventricular septal defect repair depends largely on the function of the left atrioventricular valve. Given the exposure of this valve to systemic pressures, postoperative haemodynamic management has been of interest, though practices are variable. METHODS: A single-centre, retrospective study of infants less than 1 year of age admitted to the paediatric cardiac ICU following atrioventricular septal defect repair between January 2022 and May 2025 was conducted. Utilising high-fidelity physiologic data, the primary aim of this study was to characterise haemodynamics in the first 48 h of progression of left atrioventricular valve regurgitation after complete repair. Regurgitation data was collected from echocardiograms. Generalised estimation equation modelling was done to help further isolate the association of worsening left atrioventricular valve regurgitation with haemodynamic variables. RESULTS: Among twenty-eight patients, nine (32%) exhibited worsening left atrioventricular valve regurgitation. Haemodynamic parameters significantly correlated with worse left atrioventricular valve regurgitation were increased mean arterial blood pressure, increased blood pressure variability, and decreased cerebral and renal near-infrared spectroscopy. Of note, blood pressure variability had a greater association with worsening left atrioventricular valve regurgitation when compared to absolute mean arterial blood pressure. DISCUSSION: In infants recovering from atrioventricular septal defect repair, early postoperative haemodynamic alterations, in particular mean arterial blood pressure variability, are associated with worse left atrioventricular valve function. A high cardiac output, low systemic vascular resistance state with minimal blood pressure variability appears optimal to decrease impact on the left atrioventricular valve.