Early and Mid-term Results of Patients Who Underwent Surgical Repair of Ventricular Septal Defect After The Infantile Period

Abstract

Introduction: The purpose of this study is to evaluate the mortality, morbidity, postoperative course, and mid-term complications of patients who underwent surgical repair of ventricular septal defect (VSD) after the infantile period. Patients and Methods: We retrospectively reviewed 80 patients, older than 1 year, who were operated in our center between 2014 and 2018. We defined "prolonged" as the condition in which the mechanical ventilation was more than 24 hours, ICU stay was longer than 3 days, and hospital stay was longer than 7 days. We considered cardiopulmonary resuscitation, need for extracorporeal membrane oxygenator, complete atrioventricular block requiring permanent pacemaker (PM) implantation, diaphragm paralysis, neurological complications, acute renal failure, and unplanned reoperation as the major adverse events (MAE). Results: The median age of patients was 3 (1.5-20) years. There were 31 (38.8%) female patients in our study. The median operation weight was 12.3 kg (8-60). Indications for operations were pulmonary hypertension (PH) in 30 (37.5%) patients, aortic regurgitation and aortic valve prolapse in 30 (37.5%) patients, and left ventricular (LV) dilatation in 20 (25%) patients. We did not observe mortality in any of the cases. We observed MAE only in one patient (1.3%) (PM implantation). The mean follow-up period was 2.9 ± 1.9 years. Pulmonary arterial pressure decreased significantly after surgery (20% vs. 0% of patients with severe PH, p < 0.001). Left ventricular end-diastolic diameters (LVEDDs) were significantly decreased after operation, and this condition persisted in the mid-term follow-ups (LVEDD: 36.9 ± 9.7 vs. 33.0 ± 6.6, p= 0.02). Conclusion: Patients with VSD who are awaiting spontaneous closure after the infantile age are highly recommended to undergo rigorous follow-ups. A meticulous examination of patients with late onset VSD preoperatively with a prompt referral to surgery will maintain satisfactory outcomes in early and late mortality and morbidity rates.