Permanent complete heart block following surgical closure of isolated ventricular septal defect

Abstract

A serious complication after surgical closure of ventricular septal defect (VSD) is complete heart block (CHB). It continues to be a leading cause of long-term postoperative cardiac morbidity despite all surgical technical improvements, especially with performance of more surgical procedures in increasingly younger patients. ObjectiveThis study was undertaken to determine the incidence of early postoperative CHB requiring pacemaker implantation following surgical repair of isolated ventricular septal defect, and try to identify possible procedural risk factors. DesignProspective study design. SettingMulticenter study: Ain-Shams University Hospital, Aboul Reesh Student Hospital and The National Heart Institute. MethodWe reviewed four hundred patients who had a surgical repair of isolated VSD from 2009 to 2011. Results14 out of 400 patients (3.5%) developed permanent post-operative CHB. All; but one; underwent closure of large perimembranous VSD. CHB patients had a significant lower body weight (8.36 vs. 12.68kg, p<0.01), longer ACC time (42.6 vs. 36.4min, p<0.01), longer CPB time (75.4 vs. 67.4min, p<0.01) and longer hospital stay (19 vs. 8.3days, p<0.01). Tricuspid valve detachment was performed in 28 patients (7%) and was associated with a higher incidence of CHB (7% vs. 3.75%, p=0.6). ConclusionLarge perimembranous VSD and lower body weight appear to be independent risk factors for permanent CHB following the surgical closure of isolated VSD.