Conduction disorders after perimembranous ventricular septal defect closure: continuous versus interrupted suturing techniques

Abstract

OBJECTIVES The aim of this study was to investigate postoperative conduction disorder differences between continuous and interrupted suturing techniques for the closure of perimembranous outlet-type ventricular septal defects (VSDs) in both tetralogy of Fallot (ToF) and isolated VSD cases. METHODS Patients aged 4 years or younger who underwent VSD closure for ToF (n = 112) or isolated perimembranous outlet-type VSD (n = 73) from April 2010 to December 2018 at 3 centres were reviewed. Patients either received continuous suturing for ToF (C-ToF, n = 58) or isolated VSD (C-VSD, n = 50), or interrupted suturing for ToF (I-ToF, n = 54) or isolated VSD (I-VSD, n = 23). Cohorts did not differ in preoperative characteristics. Postoperative conduction disorder differences upon discharge and postoperative year 1 (POY1) were evaluated by electrocardiography. RESULTS The C-ToF group showed significantly shorter PQ intervals (124.0 vs 133.5 ms; P = 0.042 upon discharge, 125.3 vs 133.5 ms; P = 0.045 at POY1) and QRS durations (98.0 vs 106.2 ms; P = 0.031 upon discharge, 97.3 vs 102.5 ms; P = 0.040 at POY1) than the I-ToF group. Right bundle branch block incidence was significantly lower in the C-ToF versus I-ToF groups (56.8 vs 75.9; P = 0.045 upon discharge, 56.8 vs 75.9; P = 0.045 at POY1). Heart rates were significantly lower in the C-ToF versus I-ToF groups at POY1 (109.2 vs 119.3 bpm; P < 0.001). No parameters significantly differed between C-VSD and I-VSD groups. Multivariable analyses confirmed the group (C-ToF versus I-ToF) as a significant covariate in postoperative heart rate, PQ interval, QRS duration and right bundle branch block outcomes at POY1 (P = 0.013, 0.027, 0.013 and 0.014, respectively). CONCLUSIONS A continuous suturing technique for the closure of outlet-type VSD in ToF could reduce the incidence of postoperative right bundle branch block, shorten the PQ interval and lower heart rate. Subject collection 110, 138, 139.

Knowledge, awareness, and prevalence of various types of suturing techniques used for intraoral wound closure

“…According to one study, it was found that interrupted sutures have great tensile strength and can be placed easily and other advantages such as reducing cases of wound edema, etc. [ 29 ] According to a study by Osunde et al .,[ 30 ] at the 24 and 48 h postoperative evaluations, the suture-free method resulted in decreased discomfort, edema, and trismus. Thus, in some cases, it can be said that suturing is not required; this finding can also be confirmed by another study by Waite and Cherala[ 31 ] which showed significant postoperative outcomes in multiple instances of impacted third molar that required sectioning performed without suturing (secondary healing).…”

Ventricular Septal Defect Exposure by Tricuspid Valve Chordal Detachment—A Retrospective Matched Study

“…However, when the VSD is obscured by the tricuspid valve (TV) tensor apparatus, the repair can be more complex and can result in a suboptimal repair leaving a residual VSD, tricuspid valve insufficiency, or postoperative rhythm complications such as complete atrioventricular (AV) block and right bundle branch block (RBBB). [2][3][4] As a result, surgeons have adopted adjuncts to the transatrial method of repairing the VSD such as tricuspid valve septal leaflet detachment and tricuspid valve chordae tendineae detachment to improve the exposure while repairing the VSD. [5][6][7] However, concerns remain over possible associated complications, particularly in relation to TV chordal detachment.…”