Risk factors for deleyed recovery after surgical closure of congenital ventricular septal defect in infants with low weight_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 LI Kun , SHEN Qihui , WANG Pingfan , BAI Xiling , JIA Xiangjie , WU Zhenyu , SONG Zheng , YAN Liwei , WANG Mingwei

Department of Pediatric Heart Center, Henan Provincial Chest Hospital, Zhengzhou, 450000, P.R.China;

Corresponding author：

LI Kun, Email: lk870428@126.com

Keywords：

Congenital heart diseases; ventricular septal defect; low weight; surgery

DOI：

10.7507/1007-4848.202003079

Video：

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Objective To reveal the risk factors for delayed recovery and complications in infants with weight≤5.0 kg after surgical ventricular septal defect (VSD) closure.Methods We retrospectively reviewed a consecutive series of 86 patients with weight≤5.0 kg who were admitted to our institution for surgical VSD closure between January 2016 and July 2019, including 31 males and 55 females with an age of 17-266 (80.3±40.4) d and a weight of 2.5-5.0 (4.4±0.6) kg. The VSDs were divided into perimembranous (n=65, 75.6%), subaortic (n=17, 19.8%) and subaortic combined muscular types (n=4, 4.7%). Mechanical ventilation (MV) time≥24 h or ICU stay≥72 h were defined as delayed recovery. Death, sudden circulatory arrest, complete heart block requiring a permanent or temporary pacemaker implantation, neurological complications, reoperation (for residue shunt or valvular regurgitation), reintubation and diaphragmatic paralysis were considered as significant major adverse events.Results There was no death, reoperation due to residual VSD or neurological complication. Totally 51 (59.3%) patients had MV timec≥24 h and 51 (59.3%) patients stayed in the ICU≥72 h. Two (2.3%) patients required temporary pacemaker and six (7.0%) patients required reintubation. During the follow-up of 3-36 (15.8±8.8) months, 1 patient died of pneumonia after discharge, 5 patients suffered mild tricuspid valve regurgitation and 1 patient suffered decreased left ventricular systolic function in the follow-up. No aortic valve injuries occurred.Conclusion For patients whose weight≤5.0 kg, short-term results of surgical VSD closure are excellent. Low weight and age may prolong MV time; low birth weight and pulmonary hypertension may prolong ICU stay, but are not independent risk factors.

Citation： LI Kun, SHEN Qihui, WANG Pingfan, BAI Xiling, JIA Xiangjie, WU Zhenyu, SONG Zheng, YAN Liwei, WANG Mingwei. Risk factors for deleyed recovery after surgical closure of congenital ventricular septal defect in infants with low weight. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(1): 64-69. doi: 10.7507/1007-4848.202003079 Copy

1.	Mitchell SC, Korones SB, Berendes HW. Congenital heart disease in 56,109 births. Incidence and natural History. Circulation, 1971, 43(3): 323-332.
2.	Lillehei CW, Cohen M, Warden HE, et al. The results of direct vision closure of ventricular septal defects in eight patients by means of controlled cross circulation. Surg Gynecol Obstet, 1955, 101(4): 446-466.
3.	Andersen HØ, de Leval MR, Tsang VT, et al. Is complete heart block after surgical closure of ventricular septum defects still an issue? Ann Thorac Surg, 2006, 82(3): 948-956.
4.	Anderson BR, Stevens KN, Nicolson SC, et al. Contemporary outcomes of surgical ventricular septal defect closure. J Thorac Cardiovasc Surg, 2013, 145(3): 641-647.
5.	Aydemir NA, Harmandar B, Karaci AR, et al. Results for surgical closure of isolated ventricular septal defects in patients under one year of age. J Card Surg, 2013, 28(2): 174-179.
6.	Schipper M, Slieker MG, Schoof PH, et al. Surgical repair of ventricular septal defect; contemporary results and risk factors for a complicated course. Pediatr Cardiol, 2017, 38(2): 264-270.
7.	Scully BB, Morales DL, Zafar F, et al. Current expectations for surgical repair of isolated ventricular septal defects. Ann Thorac Surg, 2010, 89(2): 544-549.
8.	Kansy A, Ebels T, Schreiber C, et al. Association of center volume with outcomes: analysis of verified data of European Association for Cardio-thoracic Surgery Congenital Database. Ann Thorac Surg, 2014, 98(6): 2159-2164.
9.	Siehr SL, Hanley FL, Reddy VM, et al. Incidence and risk factors of complete atrioventricular block after operative ventricular septal defect repair. Congenit Heart Dis, 2014, 9(3): 211-215.
10.	Kogon B, Butler H, Kirshbom P, et al. Closure of symptomatic ventricular septal defects: how early is too early? Pediatr Cardiol, 2008, 29(1): 36-39.
11.	Ergün S, Genç SB, Yildiz O, et al. 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. Braz J Cardiovasc Surg, 2019, 34(3): 335-343.
12.	Trakas E, Domnina Y, Panigrahy A, et al. Serum neuronal biomarkers in neonates with congenital heart disease undergoing cardiac surgery. Pediatr Neurol, 2017, 72: 56-61.
13.	Mittnacht AJ, Thanjan M, Srivastava S, et al. Extubation in the operating room after congenital heart surgery in children. J Thorac Cardiovasc Surg, 2008, 136(1): 88-93.
14.	Polito A, Patorno E, Costello JM, et al. Perioperative factors associated with prolonged mechanical ventilation after complex congenital heart surgery. Pediatr Crit Care Med, 2011, 12(3): e122-e126.
15.	Hamilton BC, Honjo O, Alghamdi AA, et al. Efficacy of evolving early-extubation strategy on early postoperative functional recovery in pediatric open-heart surgery: a matched case-control study. Semin Cardiothorac Vasc Anesth, 2014, 18(3): 290-296.
16.	Amin Z, Danford DA, Lof J, et al. Intraoperative device closure of perimembranous ventricular septal defects without cardiopulmonary bypass: preliminary results with the perventricular technique. J Thorac Cardiovasc Surg, 2004, 127(1): 234-241.
17.	Roos-Hesselink JW, Meijboom FJ, Spitaels SE, et al. Outcome of patients after surgical closure of ventricular septal defect at young age: longitudinal follow-up of 22-34 years. Eur Heart J, 2004, 25(12): 1057-1062.
18.	Dodge-Khatami A, Knirsch W, Tomaske M, et al. Spontaneous closure of small residual ventricular septal defects after surgical repair. Ann Thorac Surg, 2007, 83(3): 902-905.

1. Mitchell SC, Korones SB, Berendes HW. Congenital heart disease in 56,109 births. Incidence and natural History. Circulation, 1971, 43(3): 323-332.
2. Lillehei CW, Cohen M, Warden HE, et al. The results of direct vision closure of ventricular septal defects in eight patients by means of controlled cross circulation. Surg Gynecol Obstet, 1955, 101(4): 446-466.
3. Andersen HØ, de Leval MR, Tsang VT, et al. Is complete heart block after surgical closure of ventricular septum defects still an issue? Ann Thorac Surg, 2006, 82(3): 948-956.
4. Anderson BR, Stevens KN, Nicolson SC, et al. Contemporary outcomes of surgical ventricular septal defect closure. J Thorac Cardiovasc Surg, 2013, 145(3): 641-647.
5. Aydemir NA, Harmandar B, Karaci AR, et al. Results for surgical closure of isolated ventricular septal defects in patients under one year of age. J Card Surg, 2013, 28(2): 174-179.
6. Schipper M, Slieker MG, Schoof PH, et al. Surgical repair of ventricular septal defect; contemporary results and risk factors for a complicated course. Pediatr Cardiol, 2017, 38(2): 264-270.
7. Scully BB, Morales DL, Zafar F, et al. Current expectations for surgical repair of isolated ventricular septal defects. Ann Thorac Surg, 2010, 89(2): 544-549.
8. Kansy A, Ebels T, Schreiber C, et al. Association of center volume with outcomes: analysis of verified data of European Association for Cardio-thoracic Surgery Congenital Database. Ann Thorac Surg, 2014, 98(6): 2159-2164.
9. Siehr SL, Hanley FL, Reddy VM, et al. Incidence and risk factors of complete atrioventricular block after operative ventricular septal defect repair. Congenit Heart Dis, 2014, 9(3): 211-215.
10. Kogon B, Butler H, Kirshbom P, et al. Closure of symptomatic ventricular septal defects: how early is too early? Pediatr Cardiol, 2008, 29(1): 36-39.
11. Ergün S, Genç SB, Yildiz O, et al. 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. Braz J Cardiovasc Surg, 2019, 34(3): 335-343.
12. Trakas E, Domnina Y, Panigrahy A, et al. Serum neuronal biomarkers in neonates with congenital heart disease undergoing cardiac surgery. Pediatr Neurol, 2017, 72: 56-61.
13. Mittnacht AJ, Thanjan M, Srivastava S, et al. Extubation in the operating room after congenital heart surgery in children. J Thorac Cardiovasc Surg, 2008, 136(1): 88-93.
14. Polito A, Patorno E, Costello JM, et al. Perioperative factors associated with prolonged mechanical ventilation after complex congenital heart surgery. Pediatr Crit Care Med, 2011, 12(3): e122-e126.
15. Hamilton BC, Honjo O, Alghamdi AA, et al. Efficacy of evolving early-extubation strategy on early postoperative functional recovery in pediatric open-heart surgery: a matched case-control study. Semin Cardiothorac Vasc Anesth, 2014, 18(3): 290-296.
16. Amin Z, Danford DA, Lof J, et al. Intraoperative device closure of perimembranous ventricular septal defects without cardiopulmonary bypass: preliminary results with the perventricular technique. J Thorac Cardiovasc Surg, 2004, 127(1): 234-241.
17. Roos-Hesselink JW, Meijboom FJ, Spitaels SE, et al. Outcome of patients after surgical closure of ventricular septal defect at young age: longitudinal follow-up of 22-34 years. Eur Heart J, 2004, 25(12): 1057-1062.
18. Dodge-Khatami A, Knirsch W, Tomaske M, et al. Spontaneous closure of small residual ventricular septal defects after surgical repair. Ann Thorac Surg, 2007, 83(3): 902-905.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for deleyed recovery after surgical closure of congenital ventricular septal defect in infants with low weight

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