Conduction disorders in continuous versus interrupted suturing technique in ventricular septal defect surgical repair

Abstract

Background:Ventricular septal defects (VSD) is one of the most frequent congenital cardiac malformations and cardiac conduction disorders are still one of the serious postoperative complications in this surgery.Objectives:This study aimed to compare the incidence of conduction disorders with the use of continuous compared to interrupted suturing techniques in VSD surgical repair.Patients and Methods:Previously recorded data of 231 patients who underwent surgical closure of VSD between January 2009 and January 2012 at the Rajaie cardiovascular medical and research center were retrospectively reviewed. VSD surgical repair was performed using continues suturing technique in group A patients (n = 163, 70.6%) and interrupted suturing technique in group B patients (n = 68, 29.4%).Results:The most common concomitant congenital anomaly was Tetralogy of Fallot (27.3%). Twenty-four (10.4%) patients had intraoperative cardiac arrhythmia, including 19 (8.2%) transient and 5 (2.2 %) permanent arrhythmia. During their ICU stay, ventricular arrhythmia and complete heart block were observed in 34 (14.7%) and 5 patients (2.2%), respectively. At the time of the last follow-up, incomplete right bundle branch block (RBBB), complete RBBB, RBBB with left anterior hemi-block, and complete heart block were identified in 84 (36.4%), 42 (18.2%), 29 (12.6%), and 5 patients (2.2%), respectively. The results revealed that group A patients were most likely to have had cardiac arrhythmias during their ICU stay and at the time of last follow-up (P < 0.001), while the intraoperative incidence of cardiac arrhythmia during surgery was not statistically significant between the two groups (P = 0.06).Conclusions:In the absence of any statistical differences in the other risk factors between the two groups, the difference in the incidence of conduction disorders can be attributed to the type of suturing used during the procedure.

Conduction system disorders after surgical patch closure of ventricular septal defects; a comparison between two suturing techniques

“…RBBB with right anterior heart block was detected in 5.5% and 1.4% in the continuous and interrupted suturing groups; respectively. This is similar to what was observed by Gholampour-Dehakі and associates, where 18.2% of their cases had complete RBBB, and 12.6% had RBBB with right anterior hemі-block [3]. The clinical implication of long-standing RBBB has been fully reported by Pederson and colleagues who studied the long-term effects of RBBB on LV function after surgіcal closure of VSD.…”

“…In their interrupted technique group, the incidence of CHB and the operative mortality were 2.2% and 0.4%, respectively. Furthermore, 3.9% of their patients needed reoperation for residual VSD with no valve-related complications and good left ventricular (LV) function postoperatively [3]. Our findings suggest that the incidence of conduction defects was very low with both methods of closure, and conduction defects were similar in the two groups during the followup.…”

“…VSD is the most common congenіtal heart defects requiring surgіcal repair [3]. Conduction system defects, especially CHB are serious complications of VSD closure and the leading cause of cardiac morbidity during the long-term follow-up, especially when performing surgіcal repairs in younger patients [7].…”

“…The same degree of traction and tension while anchoring the patch is essential during both continuous or inter¬rupted suture techniques, and this maneuver is used to achieve good surgical exposure [3]. Postoperative complete heart block (CHB) can occur due to direct injury of the conduction system by the stitches or the edema complicating the repair [4].…”

“…The incidence of CHB following surgical closure of VSD varied in the literature, and it can occur in up to 3.5% in some studies [5]. Postoperative CHB negatively affects morbidity and mortality after VSD repair [3,[6][7][8][9].…”