Comparison of Continuous and Interrupted Suturing Techniques in Ventricular Septal Defect Closure

Abstract

Background: Our goal is to evaluate postoperative outcomes of continuous versus interrupted suturing techniques in ventricular septal defect (VSD) closure surgery.
 Methods: The study included 286 patients with isolated VSD who underwent VSD closure surgery between June 2010 and April 2017. VSD closure was performed by using the interrupted suturing technique in group 1 (n = 74, 25.9%) and the continuous suturing technique in group 2 (n = 212, 74.1%). The groups were compared in terms of mortality and rates of clinical morbidities such as infection and complete atrioventricular (AV) block.
 Results: Early mortality occurred in 3 cases in group 1 (4.0%) and 5 cases in group 2 (2.3%). There was no late mortality in either group. One patient from both groups required extracorporeal membrane oxygenation (ECMO) at postoperative 48 hours. Five patients in group 1 (6.8%) and 11 patients in group 2 (5.2%) developed complete AV block postoperatively and received permanent pacemaker implants. 
 Conclusion: Complication rates were similar between the patient groups operated on by using continuous and interrupted suturing techniques in our study, suggesting that neither technique is superior for VSD closure surgery.

Interrupted versus Continuous Suture Technique for Ventricular Septal Defects Surgical Closure

“…The transition from tricuspid annulus to the muscular septum where the His bundle lies besides the careless suturing in this area can cause the heart block (9) . Advances in surgical techniques and to the attention to localize and avoid damage to the conduction pathway reduced the incidence of complete heart block (17 Long-term follow up echocardiography of the studied patient showed a comparable success rate of VSDs closure under both suture techniques. Four (5.3%) patients in group 1 compared with 2 (3.1%) in group 2 had clinically and sizable significant VSD residual, with no significant differences.…”

“…In this study, the frequency of heart block that needed PPM was comparable in both groups (3.9% versus 6.3%, respectively). Similarly, Sen et al (17) did not find a statistically significant difference between the interrupted and continuous suturing techniques regarding the rates of atrioventricular block. Alternatively, Gholampour-Dehaki et al (18) recorded significantly higher incidence of conduction defects with continuous suture technique.…”

Commentary: Advanced imaging technologies may help to eliminate the need for pacemaker implantation following repair of ventricular septal defect

“…The anatomy of the atrioventricular conduction system in relation to ventricular septal defects (VSDs) has been demonstrated histologically since the early 1960s. 1,2 Subsequently, surgeons adopted strategies to close VSDs while avoiding atrioventricular conduction and that has resulted in a remarkable decrease in the incidence of complete heart block following surgical repair of VSDs. 3,4 In the account following up the early pioneering work of Lillehei repairing congenital heart defects, 4 of 27 patients in whom defect closure was attempted developed complete heart block.…”