Shallow suture at ventricular septal defect may safely reduce right bundle branch block
Dae Hyeon Kim1, Sungkyu Cho1, Woong-Han Kim1
1Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University, College of Medicine, Seoul, Republic of Korea.
Cardiology in the Young
|July 27, 2023
Summary
Shallow suturing for ventricular septal defect repair reduces right bundle branch block and tricuspid regurgitation. This alternative technique offers improved outcomes compared to traditional methods, minimizing rhythm disturbances.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Surgical Innovation
Background:
- Traditional ventricular septal defect (VSD) closure involves sutures placed far from the defect edge to prevent rhythm issues.
- This conventional method is associated with higher rates of right bundle branch block (RBBB) and tricuspid regurgitation (TR).
- An alternative shallow suturing technique at the VSD edge has been employed to mitigate these complications.
Purpose of the Study:
- To evaluate the clinical efficacy of a novel shallow suturing technique for perimembranous ventricular septal defect (pmVSD) repair.
- To compare the incidence of postoperative RBBB and TR progression between traditional and shallow suturing methods.
- To identify risk factors associated with RBBB and TR after pmVSD closure.
Main Methods:
- Retrospective review of 556 isolated pmVSD patients undergoing surgical closure between 2000 and 2019.
- Patients were categorized into traditional (Group T, n=374) and alternative shallow suturing (Group A, n=186) groups.
- Postoperative RBBB and TR progression were investigated, with risk factor analysis performed.
Main Results:
- The incidence of RBBB was significantly lower in Group A (14.9%) compared to Group T (39.6%).
- Multivariable analysis identified the traditional suturing method and patch material as significant risk factors for late RBBB.
- Progression of TR was more prevalent in patients who underwent traditional suturing.
Conclusions:
- Shallow suturing at the VSD edge is a viable alternative for pmVSD repair.
- This technique demonstrates a reduced rate of RBBB and TR progression.
- The findings suggest that shallow suturing can improve surgical outcomes for VSD closure without introducing other complications.
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