DEPARTMENT OF CARDIOVASCULAR SURGERY, SHAHEED RAJAIE CARDIOVASCULAR, MEDICAL AND RESEARCH CENTER, IRAN UNIVERSITY OF MEDICAL SCIENCES, TEHRAN, IRAN
Background: This is a single institute retrospective study (from 2007 to 2008) to evaluate how patient related factors (age, weight) and type or anatomical location of ventricular septal defect (VSD) could affect the outcome of surgery.
Methods- Patients with any diagnosis who had undergone ventricular septal defect repair (a total of 252 patients) from 2007 till early 2008 at our center were evaluated retrospectively for factors which might be responsible for developing residual ventricular septal defects and heart block.
Data were analyzed through univariate and multivariate analysis.
Results: There was 2 deaths among 252 patients (0.8%). The incidence of postoperative residual ventricular septal defect was 28.2%±2.8* (71 of 252), but only 3 of them (4.2%) needed reoperation. Neither patch material (p=0.572), nor type (p=0.349) or size (p=0.599) of ventricular septal defect had any effect on this complication. The mean age and weight of patients who had residual ventricular septal defect compared to those who did not were not significantly different, although they were somewhat lower (4.7±0.7 vs.5.2±0.4 years, p=0.537; and 15.4±1.7 vs.17.9±1.1 kg, p=0.222, respectively). There were five patients (2.0%) with postoperative complete heart block (CHB) and again this was independent of the patients’ age, weight and surgical approach (transatrial or transventricular). Patients with history of previous Blalock-Taussig (BT) shunt proved to have postoperative bleeding more commonly (13%, 6 of 46 patients) than patients who had not (3.4%, or 7 of 206 patients, p=0.009). Also in patients with a history of BT shunt compared to those without it, postoperative pericardial effusion (6.5% versus 1.5%, P=0.04) and pneumonia (4.3% versus 0.5%, P=0.025) were more common.
Conclusion: It seems that for VSD repair, there are no limitations such as weight or age to proceed with the definitive surgery. Also the incidence of complications is independent of the type of anomaly or approaches for closing the defect. Finally, BT shunt has its own complications which are neither rare nor minor, so it is advisable to proceed with the definitive surgery at the first time to avoid the complications associated with BT shunt.