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Associated atrial septal defects increase perioperative morbidity after ventricular septal defect repair in infancy
C J Knott-Craig1, R C Elkins, K Ramakrishnan
1Section of Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City 73190.
Insights
Infants undergoing closure of ventricular septal defects (VSDs) with associated atrial septal defects (ASDs) face higher risks. This study highlights increased perioperative morbidity and mortality in infants with combined ASD-VSD compared to isolated VSD closure.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiovascular Surgery
Background:
- Ventricular septal defects (VSDs) are common congenital heart abnormalities.
- Closure of isolated VSDs generally carries low perioperative risk.
- Infants with co-occurring atrial septal defects (ASDs) may experience increased complications after VSD closure.
Purpose of the Study:
- To evaluate the perioperative outcomes of VSD closure in infants.
- To compare outcomes between infants with isolated VSDs and those with combined ASD-VSD.
- To identify risk factors associated with mortality and morbidity in this population.
Main Methods:
- Retrospective review of 163 infants (< or = 12 months) undergoing VSD closure since 1977.
- Subgroup analysis comparing infants with significant ASDs (ASD-VSD subgroup) to those with isolated VSDs.
- Multivariate analysis to identify risk factors for hospital death and significant perioperative morbidity.
Main Results:
- Overall hospital mortality was 3.7%, with significant morbidity in 15.5% of VSD-only cases versus 48.1% in the ASD-VSD subgroup (p < 0.001).
- Risk factors for mortality included multiple VSDs and early operation date.
- Risk factors for morbidity included younger age, associated ASD, VSD size, and hypothermic circulatory arrest.
Conclusions:
- Associated ASDs significantly increase perioperative morbidity and mortality in infants undergoing VSD closure.
- Younger age, ASD presence, VSD size, and hypothermic circulatory arrest are key risk factors for morbidity.
- Careful patient selection and surgical planning are crucial for improving outcomes in infants with complex VSDs.
Abstract:
Although closure of ventricular septal defects (VSDs) is currently associated with a relatively low risk, infants with associated atrial septal defects (ASDs) seem to have a higher perioperative morbidity. To clarify this impression, we reviewed our entire experience (since 1977) with closure of simple VSDs in 163 infants (age, < or = 12 months). Of these, 57 had significant ASDs (ASD-VSD subgroup). Hospital mortality was 3.7% (6/163) overall and 1.4% (2/145) since 1980. Actuarial survival at 10 years was 92% +/- 5%. Significant morbidity occurred in 15.5% (16/103) of the VSD subgroup versus 48.1% (26/54) of the ASD-VSD subgroup (p < or = 0.001). Multivariate analysis identified the presence of multiple VSDs and early date of operation as risk factors for hospital death, and younger age, an associated ASD, the size of the VSD, and use of hypothermic circulatory arrest as risk factors for significant perioperative morbidity. Compared with the VSD subgroup, the ASD-VSD subgroup had a higher hospital mortality (5.3% [3/57] versus 2.8% [3/106]), were younger (5.1 +/- 2.9 versus 7.2 +/- 2.9 months; p = 0.001), had a higher preoperative pulmonary artery pressure (70.2 +/- 19.0 versus 62.7 +/- 21.8 mm Hg; p = 0.08), needed more inotropic support (12.3% versus 3.7%; p = 0.07), needed more prolonged ventilation (3.3 versus 1.8 days; p = 0.02), and had longer postoperative hospital stays (11 versus 8 days; p = 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)