Original article
Pediatric cardiac
Current Expectations for Surgical Repair of Isolated Ventricular Septal Defects

Presented at the Fifty-fifth Annual Meeting of the Southern Thoracic Surgery Association, Austin, TX, Nov 5–8, 2008.
https://doi.org/10.1016/j.athoracsur.2009.10.057Get rights and content

Background

Ventricular septal defect (VSD) is the most commonly recognized congenital heart defect. With the development of device closure for intracardiac defects, we sought to evaluate current expectations for surgical closure of isolated VSD.

Methods

Between January 1, 2000, and December 31, 2006, 215 patients underwent isolated VSD repair at a median age of 10 months (range, 20 days to 18 years) and a median weight of 7 kg (range, 2 to 66 kg). The following VSD types were found: 172 perimembranous (80%), 28 supracristal (13%), 6 inlet (3%), and 9 muscular (4%). One hundred eight patients (50%) had evidence of congestive heart failure or failure to thrive preoperatively. Thirty-one patients (14%) had aortic valve cusp prolapse, and 63 (29%) had genetic abnormalities.

Results

Incidence of significant postoperative complications was extremely low. No patient underwent reoperation for a residual VSD. None had complete heart block. One operative mortality (0.5%) and 2 late deaths (0.9%) occurred. Median postoperative hospital length of stay was 5 days (range, 2 to 187 days). In the immediate postoperative period, 6 patients (2.8%) required reoperation. No patients were discharged on antiarrhythmic agents, had complete heart block, or required permanent pacing. At mean follow-up of 2.1 ± 2.0 years, 99.5% (211 of 212) of patients were asymptomatic from a cardiac standpoint. None exhibited greater than mild new-onset tricuspid valve regurgitation. No aortic valve injuries occurred.

Conclusions

Surgical closure of isolated VSD is a safe, effective therapy. Risk of death, complete heart block, and reoperation is minimal. As new technologies for VSD closure evolve, results such as these should be considered when evaluating patients, choosing therapeutic options, and counseling families.

Section snippets

Patient Population

The Texas Children's Hospital Congenital Heart Surgery Database was queried for patients 18 years of age or younger undergoing VSD repair between January 1, 2000, and December 31, 2006. The medical records of these patients were retrospectively reviewed after approval by the Baylor College of Medicine Institutional Review Board on February 2, 2007. Given the retrospective nature of the study, permission was given for waiver of consent.

Patients undergoing isolated VSD repair were extracted from

Patient Demographics

The median age at repair was 10 months (range, 20 days to 18 years) and weight was 7 kg (range, 2 to 66 kg). For the subgroup of patients with genetic abnormalities, the median age was 6.1 months (range, 37 days to 7.5 years) and the median weight was 5.4 kg (range, 2.4 to 25.7 kg), compared with nonsyndromic patients whose median age was 14.5 months (range, 20 days to 17.8 years) and median weight was 9.1 kg (range, 3.0 to 65.8 kg). The probability values for both age and weight of syndromic

Comment

Results for surgical repair of ventricular septal defects have evolved significantly since the first series of direct vision closure reported by Lillehei and colleagues in 1955 [3]. Advances in surgical technique and intraoperative and perioperative management have led to marked improvement in outcomes for these patients. Long-term survival and clinical outcomes for these patients are excellent, with one recent study citing 92% of patients in New York Heart Association class I more than 20

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