Risk Factors for Major Adverse Events after Surgical Closure of Ventricular Septal Defect in Patients Less than 1 Year of Age: A Single-Center Retrospective

Abstract

Objective To reveal the risk factors that can lead to a complicated course and an increased morbidity in patients < 1 year old after surgical ventricular septal defect (VSD) closure. Methods We reviewed a consecutive series of patients who were admitted to our institution for surgical VSD closure who were under one year of age, between 2015 and 2018. Mechanical ventilation (MV) time > 24 hours, intensive care unit (ICU) stay longer than three days, and hospital stay longer than seven days were defined as “prolonged”. Unplanned reoperation, complete heart block requiring a permanent pacemaker implantation, sudden circulatory arrest, and death were considered as significant major adverse events (MAE). Results VSD closure was performed in 185 patients. The median age was five (1-12) months. There was prolonged MV time in 54 (29.2%) patients. Four patients (2.2%) required permanent pacemaker implantation. Hemodynamically significant residual VSD was observed in six (3.2%) patients. Extracorporeal membrane oxygenation-cardiopulmonary resuscitation was performed in one (0.5%) patient. Small age (< 4 months) ( P -value<0.001) and prolonged cardiopulmonary bypass time ( P =0.03) were found to delay extubation and to prolong MV time. Low birth weight at the operation was associated with MAE ( P =0.03). Conclusion Higher body weight during operation had a reducing effect on the MAE frequency and shortened the MV duration, ICU stay, and hospital stay. As a conclusion, for patients who are scheduled to undergo VSD closure, body weight should be taken into consideration.

Prognostic Model to Predict Postoperative Adverse Events in Pediatric Patients With Aortic Coarctation

“…Fifth, variables of patient-specific factors such as height, weightfor-age z-score reflect preoperative growth, nutritional status, and perfusion of systemic circulation, so a deficiency in height and weight indicates a high risk of death and other postoperative adverse events (35,36). Finally, the variable of LVPW reflects the status of pre-operation left ventricular remodeling, but this variable was discovered also to be related to other factors such as diagnosis group (LVPW was higher in the group without VSD), age (to a certain extent reflecting the course of disease for congenital malformation), and severe PH (LVPW was greater in the non-severe PH group than in the severe PH group) in this study.…”

Short- and Long-term Outcome After Interventional VSD Closure: A Single-Center Experience in Pediatric and Adult Patients

“…However, both methods carry a potential risk of complete atrioventricular block (cAVB). Studies show cAVB occurs at a rate of 0.1-6.8% after interventional VSD closure [4][5][6][7][8][9][10][11][12][13] and < 2% after surgical VSD closure [14,15]. Surgical closure can be considered for the majority of patients but disadvantages include the use of general anesthesia, sternotomy, and extracorporeal circulatory support, which results in longer recovery and hospital time [16][17][18].…”

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

“…Anderson et al reported that the incidence of MAE was 5.3% and Schipper et al reported the incidence of MAE was 2.9% in their respective studies (1,3) . Our study focused on the population under the age of one year and found that the incidence of MAE was 5.4% (7) . However, we observed that the incidence of MAO was quite low in the patient population after the age of one year.…”