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Outcome of ventricular septal defect repair in a developing country
Balu Vaidyanathan1, Stephen J Roth, Suresh G Rao
1Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Insights
Early ventricular septal defect (VSD) repair in infants is safe, even with poor nutrition or pneumonia. These factors do not increase mortality after VSD surgery.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Surgical Outcomes
Background:
- Ventricular septal defect (VSD) is a common congenital heart anomaly.
- Outcomes after VSD repair in developing countries can be affected by nutritional status and infections.
- Early surgical intervention is crucial for infants with large VSDs.
Purpose of the Study:
- To evaluate the impact of preoperative nutrition and lung infection on outcomes following VSD repair in infants.
- To determine if these factors influence mortality, ventilation duration, ICU stay, and hospital stay.
Main Methods:
- A cohort of 100 infants with large VSDs undergoing surgical repair in South India was analyzed.
- Preoperative nutritional status (weight/length Z scores) and presence of pneumonia were assessed.
- Primary outcomes included postoperative death, mechanical ventilation duration, ICU, and hospital stay.
Main Results:
- Preoperative nutritional status was poor (mean weight Z score -2.8).
- Pneumonia was present in 25% of infants.
- While younger age and pneumonia were associated with longer ventilation, ICU, and hospital stays, neither nutrition nor pneumonia impacted mortality.
Conclusions:
- Preoperative nutritional status and pneumonia do not adversely affect mortality rates after VSD repair.
- Surgical repair of large VSDs in infants should not be postponed due to poor nutrition or preoperative pneumonia.
Objectives:
To examine the impact of nutrition and lung infection on outcome early after ventricular septal defect (VSD) repair in infants in a developing country.
Study Design:
One hundred consecutive infants (age, 7.4 +/- 3.3 months) with large VSD(s) who underwent surgical repair at one institution in South India from July 1998 to June 2000 were analyzed. Primary outcome variables were postoperative death, duration of mechanical ventilation, intensive care unit (ICU) stay, and hospital stay. Preoperative variables analyzed included age, weight and length Z scores, and lung infection.
Results:
Preoperative nutrition was poor (weight Z score, -2.8 +/- 1.3), and 25 patients had pneumonia. Six patients died after repair. No preoperative variable was associated with death. Mechanical ventilation, ICU stay, and hospital stay were longer for younger patients (r (s) for ventilation, -0.23, P =.02; for ICU stay, -0.33, P <.001; for hospital stay, -0.27, P =.007) and for those with preoperative pneumonia (median ventilation duration, 46 vs 24 hours, P <.001; median ICU stay 7 vs 4 days, P <.001; median hospital stay 10 vs 7 days, P =.001). Preoperative weight and length Z scores were not associated with any outcome variable.
Conclusions:
Poor nutritional status, preoperative pneumonia, and age do not increase mortality rates after VSD repair. Repair of large VSDs should not be delayed because of these preoperative characteristics.