Results of surgical closure of ventricular septal defects and determination of factors affecting postoperative complications

Background and Aims: Ventricular septal defect (VSD) is the most common congenital heart defect and patients undergoing VSD repair play an important role in pediatric cardiology practice. Although the development of surgical techniques and progression of postoperative patient care in recent years, complications are still being seen. Therefore, to identify the associated rick factors is important for good patient selection, planning the appropriate surgical technique and optimal timing of corrective operation, thus improving outcomes. In this study, we evaluated the surgical outcomes in pediatric patients undergoing VSD repair and the risk factors affecting complications. Materials and methods: A total of 141 pediatric patients who underwent VSD repair between January 2008 and March 2017 were included in the study. The medical records of the patients were analyzed retrospectively. Demographic characteristics, concomitant diseases, preoperative echocardiographic findings and surgical characteristics were evaluated and independent risk factors were determined. The effects of these independent markers on postoperative complications (prolonged intensive care and intubation times, arrhytmia, tricuspit regurgitation, residual defect, reoperation, death) were analyzed. Results: The mean age of the patients was 20,1 (1-195) months and the mean body weight was 8,3 (2,7-55) kilogram. The mean follow-up duration was 29,2 (1-122) months. Postoperative complication rate was 63,8% but when the patients with hemodynamically insignificant residual defects and mild/ grade 1 tricuspid regurgitation excluded, the complication rate was 40,4%. Four patients underwent re-operation due to residual defect and subaortic ridge formation. Mortality was seen in 13 patients, but 3 were considered unrelated to the operation. The mortality rate with associated to the operation was 7%. As results of univariate analyzes, the only risk factor affecting mortality was preoperative inotropic support(p<0,001). Residual rate was significantly increasedin patients who underwent pulmonary artery banding prior to corrective surgery(p=0,021). The only variable affecting postoperative intensive care and intubation times was long aortic cross clamp duration (p=0,034 ve p=0,021). It was found that low operating weight and postoperative infection development increased the incidence of reentubation (p=0,013 ve p=0,009). In the presence of genetic disease and ventricular hypertrophy, the incidence of complication was significantly increased. There was no significant risk factor for postoperative pericardial effusion, neurological deficit, tricuspid regurgitation and reoperation. Gender, VSD type, shunt amount (Qp/Qs), surgical type (primary closure or patch placement), patch selection, surgical approach and cardiopulmonary bypass time did not significantly affect any variables. Conclusion: In our study, it was found that low operative weight, presence of genetic disease, ventricular hypertrophy, aortic cross clamp duration and infection were important risk factors for postoperative complications in patients who underwent surgical repair of VSD. Considering these operational techniques and patient characteristics, it can be predicted that the correction operation will cause less complications.