Surgical Closure of Ventricular Septal Defect: Contemporary Results and Risk Factors for Electrophysiological Changes

Abstract

Abstract Background The surgical closure of a ventricular septal defect is a commonly performed procedure. Postoperative ECG changes are common findings that needs 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 ventricular septal defects. Methodology A Prospective, non-randomized 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 sub-aortic membrane or Hypertrophic obstructive cardiomyopathy, Iatrogenic VSD, need Aortic root dilatation with VSD closure were excluded. 12-lead ECG was reported on ICU admission and daily thereafter till discharge. Various demographic and peri-operative data were recorded and its correlation to the presence of electrophysiological changes and final outcomes were analyzed. Results 200 patients who underwent surgical VSD closure were included. Arrhythmias occurred in 41 patients (20,5%). The encountered arrhythmias were sinus bradycardia with junctional escape in 24 patients, junctional ectopic tachycardia in 10 patients, supraventricular tachycardia in 2 patients, premature complex in 2 patients, 2nd degree heart block in 4 patients and 3rd degree block in 2 patients. Mother's hypertension, preoperative mechanical ventilation, Associated cardiac anomalies, Down syndrome, size of VSD, type of VSD, Total bypass time, Aortic cross clamp time, Concomitant procedures, Intra operative pacing, and residual VSD, were identified in a univariate analysis as Risk factors for occurrence of arrhythmias. The multivariate logistic regression analysis shows that the most significant risk factors for the occurrence of ECG changes were outlet VSD type, mitral valve repair as a concomitant procedure and aortic cross clamp time >45 minutes. 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, intensive care unit stay and mechanical ventilation. Longer crossclamp and CPB times were significant predictors of post Op ECG changes and associated complications with prolonged ICU and hospital stay.