Surgical Repair of Ventricular Septal Defect; Contemporary Results and Risk Factors for a Complicated Course

Abstract

Surgical closure of the ventricular septal defect is the most commonly performed procedure in pediatric cardiac surgery. There are conflicting data on weight at operation as risk factor for a complicated course. We performed a retrospective evaluation of mortality and morbidity in all patients undergoing surgical ventricular septal defect closure at our institution between 2004 and 2012 to identify risk factor for a complicated course. Multivariate logistic regression modeling was performed to identify risk factors for a complicated course. 243 patients who underwent surgical ventricular septal defect closure were included. Median age at operation was 168.0 days (range 17–6898), the median weight 6.0 kg (range 2.1–102.0). No deaths occurred. Two patients (0.8%) required a pacemaker for permanent heart block. Five patients (2.1%) underwent reoperation for a hemodynamically important residual ventricular septal defect. No other major adverse events occurred. No risk factors for major adverse events could be established. Multivariate analysis identified a genetic syndrome, long bypass time and low weight at operation as independent risk factors for a prolonged intensive care stay (>1 day) and prolonged ventilation time (>6 h). Contemporary results of surgical VSD closure are excellent with no mortality and low morbidity in this series. Although it is associated with increased ventilation time and a longer hospital stay, low bodyweight at operation is not associated with an increased risk of complications or major adverse events in our series.

A meta-analysis of perventricular device closure of doubly committed subarterial ventricular septal defects

“…Surgical repair of dcsVSDs under cardiopulmonary bypass (CPB) is considered the gold standard treatment. However, this procedure cannot avoid the potential risk of CPB-related complications, the need for a blood transfusion, and the presence of a surgical incision scar or prolonged recovery [5,6]. With the improvement of technology and development of devices, transfemoral device closure of dcsVSDs has also been applied in some cardiac centers [7,8].…”

Characteristics of post-operated patients of interventricular communication in the Department of Pediatric Cardiology of the Hospital de Clinics

“…Con la reparación primaria del defecto se logra restituir tempranamente la fisiología normal, reducir el impacto en el crecimiento y desarrollo del niño, y se evita la endocarditis bacteriana (4) . La reparación quirúrgica de la CIV es una de las cirugías cardiacas pediátricas que se realizan con más frecuencia y las actuales técnicas quirúrgicas, de anestesia y cuidados perioperatorios, permiten la reparación con baja mortalidad y con muy baja incidencia de complicaciones (2,(17)(18)(19) . La cirugía se realiza bajo circulación extracorpórea, a través de una esternotomía mediana (2,19) .…”

“…La reparación quirúrgica de la CIV es una de las cirugías cardiacas pediátricas que se realizan con más frecuencia y las actuales técnicas quirúrgicas, de anestesia y cuidados perioperatorios, permiten la reparación con baja mortalidad y con muy baja incidencia de complicaciones (2,(17)(18)(19) . La cirugía se realiza bajo circulación extracorpórea, a través de una esternotomía mediana (2,19) . La mortalidad quirúrgica global es baja, de menos de 3% para la CIV aislada o CIV con insuficiencia aórtica en niños de más de un año de edad, y ligeramente mayor en los lactantes y pacientes con defectos múltiples.…”

The Role of Hedgehog Signalling in the Formation of the Ventricular Septum

“…To prevent these severe consequences, VSDs are currently treated with surgery. Although surgical repair is the most frequently performed procedure in pediatric cardiac surgery, and although this treatment is successfully applied in most cases [ 31 , 32 ], surgical closure of VSDs entails several risks, like chronotropic incompetence, operative mortality, or late death [ 32 , 33 ]. To avoid surgery and to develop alternative therapies to treat VSDs, it is necessary to know the molecular mechanisms underlying ventricular septal development.…”