A Retrospective Survey Comparing Suture Techniques Regarding the Risk of Permanent Epicardial Pacemaker Implantation After Ventricular Septal Defect Closure.

Mehmet Fatih Ayık,Münevver Dereli,Emrah Şişli,Hatice Şahin,Yüksel Atay,Yasemin Özdemir Şahan,Reşit Ertürk Levent

doi:10.21470/1678-9741-2018-0010

Mehmet Fatih Ayık, Münevver Dereli + Show 5 more

Open Access

https://doi.org/10.21470/1678-9741-2018-0010

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Abstract

ObjectiveThe aim of this study is to compare the continuous and combined suturing techniques in regards to the needing epicardial pacing at the time of weaning from cardiopulmonary bypass (EP-CPB) and to evaluate permanent epicardial pacemaker (PEP) implantation in patients who had undergone surgical ventricular septal defect (VSD) closure.MethodsThis single-centre retrospective survey includes 365 patients who had consecutively undergone VSD closure between January 2006 and October 2015. ResultsThe median age and weight of the patients were 15 months (range 27 days - 56.9 years) and 10 kg (range 3.5 - 100 kg), respectively. Continuous and combined suturing techniques were utilised in 302 (82.7%) and 63 (17.3%) patients, respectively. While 25 (6.8%) patients required EP-CPB, PEP was implanted in eight (2.2%) patients. Comparison of the continuous and combined suturing techniques regarding the need for EP-CPB (72% vs. 28%, P=0.231) and PEP implantation (87.5% vs. 12.5%, P=1.0) were not statistically significant. The rate of PEP implantation in patients with perimembraneous VSD without extension and perimembraneous VSD with inlet extension did not reveal significant difference between the suture techniques (P=1.0 and P=0.16, respectively). In both univariate and multivariate analyses, large VSD (P=0.001; OR 8.63; P=0.011) and perimembraneous VSD with inlet extension (P<0.001; OR 9.02; P=0.005) had a significant influence on PEP implantation.ConclusionBoth suturing techniques were comparable regarding the need for EP-CPB or PEP implantation. Caution should be exercised when closing a large perimembraneous VSD with inlet extension.

Highlights

Ventricular septal defect (VSD) is the most frequent congenital heart pathology faced by congenital cardiac surgeons[1,2,3]
The rate of permanent epicardial pacemaker (PEP) implantation in patients with perimembraneous VSD without extension and perimembraneous VSD with inlet extension did not reveal significant difference between the suture techniques (P=1.0 and P=0.16, respectively). In both univariate and multivariate analyses, large VSD (P=0.001; OR 8.63; P=0.011) and perimembraneous VSD with inlet extension (P
While the reported incidence of surgically induced permanent complete heart block (CHB) after VSD closure remains between 0 and 8%[1,2,4,5,6,7,8,9,10,11], the occurrence of iatrogenic CHB is expected to be less than 1% in which the occurrence has been mainly attributed to biological variations and lack of awareness of the disposition of the atrioventricular conduction axis[1,9,12,13]

Summary

Introduction

Ventricular septal defect (VSD) is the most frequent congenital heart pathology faced by congenital cardiac surgeons[1,2,3]. The suturing technique applied during patch closure of VSD was not described in detail in some reports[1,4,7], a variety of suturing techniques have been implemented[2,5,6,8,9,10,14,15]. The aim of this retrospective study is to compare the continuous

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