Mattress Stitch--A Modified Shallow Stitching in the Surgical Closure of Large Perimembranous Ventricular Septal Defect in Infants.

Abstract

The purpose of this study was to assess the feasibility of the mattress suturing technique in repairing large perimembranous ventricular septal defects (VSDs) in infants. This was a retrospective review of 120 patients undergoing surgical closure of perimembranous VSD between 2010 and 2012. The mattress suturing technique was performed to close the infero-posterior rim of the perimembranous VSD in 60 patients (Group I) while the conventional shallow suturing method was used in the others (Group II). Propensity-score matching was performed to adjust for potential baseline confounders, which resulted in 120 patients matched to 95 patients. Perioperative outcomes were compared. Postoperative mortality in both groups was zero. Two patients in Group II developed atrioventricular block (1 complete heart block and 1 temporal II-degree atrioventricular block) compared with none in Group I (p >0.05). Complete right bundle branch block was found in four patients in Group I and 12 patients in Group II (p = 0.035). Mean follow-up time was 26.6 ± 8.9 months. Three patients in Group II developed a small residual VSD while only one patient in Group I did during the follow-up period (p >0.05). The mattress suturing technique produced results comparable with the conventional shallow suturing method and seems to be of value in reducing the incidence of complete right bundle branch block. It appears to provide an optional method for surgical closure of large perimembranous VSDs in infants.