Surgical closure of ventricular septal defect: Contemporary results and risk factors for electrophysiological changes. | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 43, Issue 4, October 2024, Page 1571-1587 PDF (318.64 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/EJSUR.2024.300499.1111 | ||||
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| Authors | ||||
Ahmed Hassan Mohamed  ; Sherif Elasyed Soliman Azab; Ashraf Abd El-Hamid El Midany
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| Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt | ||||
| Abstract | ||||
| Background: The surgical closure of a ventricular septal defect (VSD) is a commonly performed procedure. Postoperative ECG changes are common findings that need a proper assessment to provide valuable insights into the outcomes of the patients. In this study, we investigate the potential risk factors associated with electrophysiological changes following surgical closure of VSD. Patients and Methods: A prospective, nonrandomized study was conducted from October 2020 to December 2022 on patients scheduled for VSD closure. Patients with prior abnormal congenital electrophysiological disturbances, internal pacemaker, Ebstein’s anomaly, associated subaortic membrane or hypertrophic obstructive cardiomyopathy, iatrogenic VSD, and need aortic root dilatation with VSD closure were excluded. 12-lead ECG was reported on ICU admission and daily after that till discharge. Various demographic and perioperative data were recorded, and their correlation to the presence of electrophysiological changes and outcomes were analyzed. Results: Two hundred patients who underwent surgical VSD closure were included. Arrhythmias occurred in 41 (20.5%) patients. The encountered arrhythmias were sinus bradycardia with junctional escape in 24 patients, junctional ectopic tachycardia in 10 patients, supraventricular tachycardia in two patients, premature complex in two patients, second-degree heart block in four patients, and third-degree block in two patients. Mother’s hypertension, preoperative mechanical ventilation, associated cardiac anomalies, Down syndrome, size of VSD, type of VSD, total bypass time, aortic crossclamp time, concomitant procedures, intraoperative pacing, and residual VSD were identified in univariate analysis as risk factors for occurrence of arrhythmias. Conclusion: Surgical VSD closure is a safe procedure with low mortality and morbidity rates. Younger age and lower body weight are risk factors for prolonged hospitalization, ICU stay, and mechanical ventilation. Longer cross-clamp and cardiopulmonary bypass times were significant predictors of postoperative ECG changes and associated complications with prolonged ICU and hospital stay. | ||||
| Keywords | ||||
| ECG changes; outcome predictors; risk factors; surgical closure; ventricular septal defect | ||||
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