Surgical repair of complete atrio-ventricular canal: one more approach?

Under a new name (the ’one-and-half patch’ technique) [1], the authors describe an intermediate technique (between those described at 1 and 2, below) for the surgical treatment of complete atrio-ventricular canal (CAVC) or atrio-ventricular septal defect (AVSD)—with a patch under the superior bridging leaflet (SBL) and direct attachment to the ventricular crest of the defect under the inferior bridging leaflet (IBL)— that is already advocated by some [2], who indicate that it can be used in cases with a "large" ventricular septal defect component. The technique was used in their centre in 16 cases, whereas others in their centre used the two-patch technique in 45 cases and the "modified" single-patch in 13 cases. They claimed a shorter cross-clamp time (66 m vs 81 m in the two-patch procedure) and fewer re-operations (0 vs 1 for two-patch and 3 for the modified technique). The mean follow-up period was three years. Despite the good results obtained, two questions arise: what are the advantages of this technique and is it of interest? Let us recall the two basic concepts in the repair of CAVC: