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Surgical management of ventricular septal defects in infants
Insights
For infants with symptomatic ventricular septal defect (VSD), primary intracardiac repair offers improved outcomes. This approach is now favored over the two-stage surgical method due to lower risks and better results.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Thoracic Surgery
Background:
- Infants with symptomatic ventricular septal defect (VSD) often require surgical intervention when medical therapy fails.
- Treatment decisions involve comparing the risks of a two-stage approach (pulmonary artery banding, debanding, VSD closure) versus primary intracardiac repair.
Purpose of the Study:
- To compare the outcomes of two-stage surgical repair versus primary intracardiac repair for infants with VSD.
- To determine the preferred surgical strategy for symptomatic VSD in infancy.
Main Methods:
- Retrospective analysis of infants undergoing pulmonary artery banding (1967-1976).
- Analysis of infants undergoing pulmonary artery debanding and VSD closure.
- Analysis of infants undergoing primary intracardiac repair of VSD during the same period.
- Evaluation of operative mortality, morbidity, and late outcomes for both approaches.
Main Results:
- Pulmonary artery banding had one operative death, but significant morbidity and late deaths.
- The two-stage approach (debanding and VSD closure) had three operative deaths and frequent complications.
- Primary intracardiac repair had eight operative deaths, but low associated morbidity.
- Improved results with profound hypothermia and circulatory arrest made early correction competitive.
Conclusions:
- Primary intracardiac repair of VSD in infancy is associated with favorable outcomes.
- The risks of early correction now compare favorably with the cumulative mortality of the two-stage approach.
- Primary intracardiac repair is the recommended procedure of choice for symptomatic VSD in infants.
Abstract:
Infants with ventricular septal defect (VSD) who are symptomatic despite intensive medical therapy require surgical intervention. Choice of treatment depends upon the cumulative mortality and morbidity rates of the two-stage approach of initial pulmonary artery banding followed by debanding and VSD closure as compared to the risk of primary intracardiac repair in infancy. Sixteen infants underwent pulmonary artery banding at Columbia-Presbyterian Medical Center between 1967 and 1976, with one operative death but with a significant incidence of morbidity and late death. Forty patients underwent pulmonary artery debanding and closure of VSD with three operative deaths. This second-stage procedure was frequently complicated by repair of acquired lesions. During the same 10 year period 37 infants underwent primary closure of VSD with eight operative deaths. The morbidity related to this procedure is low. With the use of profound hypothermia and circulatory arrest, results have significantly improved and the risk of early correction now compares favorably with the cumulative mortality rate of the two-stage approach. Primary intracardiac repair is the procedure of choice.