Ventricular Septal Defect Exposure by Tricuspid Valve Chordal Detachment-A Retrospective Matched Study

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Defect Repair
• Cardiovascular Surgery Techniques

Background:

• The transatrial approach is standard for pediatric ventricular septal defect (VSD) repair.
• Tricuspid valve (TV) apparatus can obscure VSD inferior borders, risking incomplete repair or heart block.
• TV chordal detachment is an alternative to TV leaflet detachment for improved surgical access.

Purpose of the Study:

• To evaluate the safety and efficacy of TV chordal detachment during VSD repair.
• To compare the incidence of postoperative complications between TV chordal detachment and standard repair.

Main Methods:

• Retrospective review of pediatric VSD repairs (2015-2018).
• Group A (n=25): VSD repair with TV chordal detachment.
• Group B (n=25): VSD repair without TV detachment (matched controls).
• Analysis of ECG and echocardiograms at discharge and 3-year follow-up for RBBB, residual VSD, and TV regurgitation.

Main Results:

• Postoperative right bundle branch block (RBBB) incidence was lower in the TV chordal detachment group (28% vs. 56% at discharge, P=0.044).
• At 3-year follow-up, RBBB incidence remained lower in the TV chordal detachment group (16% vs. 40%, P=0.059).
• No significant difference in moderate tricuspid regurgitation at discharge (16% vs. 12%, P=0.867) or significant residual VSD at 3 years.

Conclusions:

• TV chordal detachment is a safe technique for pediatric VSD repair.
• This method reduces the incidence of postoperative RBBB without increasing tricuspid regurgitation.
• No significant difference in operative time was noted between the techniques.