Ventricular Septal Defect Closure Research Articles

A case of double‐chambered right ventricle due to cap‐like fibrous tissue and aberrant chordal insertion of tricuspid valve in adult

A double-chambered right ventricle is a rare congenital heart disease where an anomalous structure divides the right ventricle into two cavities. A 78-year-old man with dyspnea was referred to our institution for a double-chambered right ventricle (DCRV) and ventricular septal defect (VSD). Echocardiography showed normal left ventricular function, right ventricular hypertrophy, and mild tricuspid regurgitation. On parasternal short-axis views, color-flow Doppler studies showed a mosaic pattern through the stenotic right ventricular outflow tract (RVOT). Cardiac catheterization showed a 122 mmHg pressure gradient between the high-pressure chamber and the low-pressure chamber of the RVOT. Computed tomography showed a cap-like structure consisting of fibrous tissue, with moderate stenosis, which divided the right ventricle into two cavities. The aberrant tendinous chords supporting the anterior leaflet of the tricuspid valve were found inserted into the anterior wall of the RV (Figure 1). Resection of the cap-like fibrous tissue and abnormal muscle (Figure 2), detachment of aberrant tendinous chords of the tricuspid valve, closure of VSD by direct suture, and tricuspid valve plasty (TVP) were performed. TVP was achieved using an artificial chordae replacement with expanded polytetrafluoroethylene (CV-5) suture and a 32-mm Physio Tricuspid annuloplasty ring (Edwards Lifeline). Postoperative echocardiography revealed no RVOT pressure gradient and a normal right ventricular pressure of 21 mmHg. In conclusion, we report a rare case of DCRV secondary to a cap-like structure fibrous tissue with anomalous chordal insertion of a tricuspid valve leaflet.

Developmental Care Practice and Documentation Variability in the Cardiac ICU.

Describe variability in developmental care practices, as documented in the electronic health record, for infants undergoing congenital heart surgery. Multicenter, retrospective, cohort study. Six pediatric cardiac centers. One hundred eighty-two infants undergoing one of three index operations: Norwood palliation, aortic arch reconstruction with ventricular septal defect closure, or arterial switch. None. Core domains of developmental care encompassing pain assessment, feeding, infant holding, caregiver involvement, therapy, and psychosocial services were reviewed. Practices varied across individuals, institutions, and the hospital stay. At five of six sites, greater than 90% of individuals had physical or occupational therapy services as part of their care, but the day of first evaluation ranged from day of admission to postoperative day 28. Similar patterns were seen in feeding team and social work involvement. Consistent documentation of developmental care was dependent on the domain and site. Of the total days reviewed (n = 1,192), pain scores were documented in 95%. In those same days, documentation of whether or not a patient was out of the crib to be held varied by site from 11% to 93%. Type of oral feeding, breast versus bottle, was documented on the day prior to discharge 48% of the time. There are significant, quantifiable variations in documented developmental care practices at both the individual and site level. More reliable documentation of developmental care practices is required to associate these variables with later outcomes and investigate disparities in individualized developmental care practices.

Application of Mivacurium in Fast-Track Anesthesia for Transthoracic Device Closure of Ventricular Septal Defects in Children.

IntroductionThe objective of this study was to investigate the effect of mivacurium in the application of fast-track anesthesia for transthoracic device closure of ventricular septal defects (VSDs) in children.MethodsThe data of 108 children who underwent transthoracic device closure of VSDs from December 2018 to June 2020 were recorded and analyzed. All children were divided into group M (mivacurium group, n=55) and group C (cisatracurium group, n=53) according to the different muscle relaxant drug used.ResultsNo statistically significant differences in general preoperative data, intraoperative hemodynamic changes, or the incidence of adverse reactions were noted between the two groups (P>0.05). However, the intubation condition rating of children in group M was better than that in group C. The onset time, duration of clinical action and recovery index of the muscle relaxant, postoperative mechanical ventilation duration, and length of intensive care unit stay in group M were significantly lower than those in group C (P<0.05).ConclusionIt is safe and feasible to use mivacurium as a muscle relaxant in children undergoing fast-track cardiac anesthesia during transthoracic device closure of VSDs.

Long-term Consequences of Ventricular Septal Defect Closure Using Nit-Occlud Le VSD Coil Device

Background:The successful management of ventricular septal defect (VSD) has been possible through the development of advanced techniques. In this regard, percutaneous VSD closure by employing different types of occluders as an alternative for surgery can help to achieve the most desirable postprocedural consequences. However, the studies reported contradictory results on the use of different brands of VSD occluders. Herein, we performed a systematic review and meta-analysis of published studies to assess pooled long-term success rate and potential complications of using the Nit-Occlud Lê VSD coil for VSD closure.Materials and Methods:Two reviewers began to deeply search the various databases for all eligible studies in accordance with the considered keywords. The inclusion criterion for retrieving the studies was to describe the mid-term or long-term consequences of VSD closing by the Nit-Occlud Lê VSD coil device. In the final, eight articles were eligible for the analysis. The follow-up time of the studies ranged from 6 months to 5 years.Results:The success rate of the procedure ranged from 87.0% to 100% considering the weight of each study, the pooled success rate of VSDs closure by Nit-Occlud Lê VSD coil device was 93.1% (95% confidence interval [CI]: 89.9% to 95.5%). The pooled prevalence of postprocedural residual shunt was estimated to be 9.6% (95%CI: 6.8% to 13.4%). The corrected pooled prevalence of trivial mild aortic regurgitation (AR) was 2.9% (95%CI: 1.5% to 5.4%); however, moderate-to-severe AR and complete heart block or right bundle branch block were shown to be rare.Conclusion:VSD closure using a Nit-Occlud Lê VSD coil device can lead to a high success rate with low rates of residual shunt, cardiac conductive or vascular disturbances.

Outcome of ventricular septal defect closure with the Nit-Occlud® Le VSD-Coil: single centre experience.

The objective of this study was to review the outcome of patients who underwent transcatheter closure of ventricular septal defect (VSD) using Nit-Occlud® Leˆ VSD-Coil.A retrospective study was carried out at King Abdulaziz Cardiac Center on all paediatric patients who underwent interventional VSD closure, during the period from 2011 and 2016. Data were collected, including demographic information, cardiac diagnosis, pre-operative diagnosis, intra-operative findings and postoperative events. Out of 46 patients, who were evaluated for VSD device closure, 17 of them were excluded; 24 patients out of 29 had successful closure of VSD using Nit-Occlud Leˆ VSD-Coil (success rate of 83%), and five cases were referred to surgery. The age group was from 2 years up to 18 years. Almost 90% of VSD was the perimembranous (PM) type (26 patients) and 3 patients (10%) with muscular VSD. Ten of the 26 PM VSDs had TV accessory tissue partially covering the VSD defects. The hemodynamic assessment showed pulmonary blood flow to systemic blood flow ratio (Qp:Qs) > 1.5 in almost all the patients who underwent defect closure. Immediate closure of the defect was achieved in 11/24 patients (45%). In five additional patients, there was a tiny residual and eight with a small residual. With 6 months of follow-up, only six patients remained with tiny residual VSD defects.The Nit-Occlud® Leˆ VSD-Coil device has minimal effects on the aortic and tricuspid valves, and there was no permanent atrioventricular block, especially in patients with PM VSDs. Patients with a residual shunt should be followed, especially for haemolysis.

Recurrent Stroke after Percutaneous Placement of Post-Infarct Septal Occluder Device

Surgical intervention for post-infarct ventricular septal defect (VSD) is a challenging procedure due to patients’ complex preoperative conditions. While percutaneous VSD closure can be considered as an alternative to surgical repair, complete closure of the defect remains difficult and is associated with various procedural complications. We report a rare case of a patient with postoperative residual shunts who experienced recurrent stroke episodes, requiring surgical intervention for repair. The patient, a 71-year-old female, developed acute anterior myocardial infarction and post-infarct VSD. Percutaneous closure with a 14-mm Amplatzer VSD occluder device was performed, yet the closure was incomplete. Following discharge, she developed multiple embolic stroke episodes, likely stemming from the residual VSD, which led to the surgical extraction of the device and VSD repair. Fibrous tissue was found to be solely attached to the core and right ventricle side of the device, whilst no fibrous tissue was observed on the side of the left ventricle. The patient has not experienced new neurological symptoms at an 18-month follow-up. Thus, it is paramount to keep in mind that an embolic stroke may occur in the setting of percutaneous post-infarct VSD closure. Surgical repair of VSD with device removal should be considered as a treatment option to such a complex case.

Transcatheter Closure of a Ragged Post-Myocardial Infarction Ventricular Septal Defect Using an Off-Label ASD Occluder

Post-myocardial infarction ventricular septal defect has become a rare event following ST Elevation Myocardial Infarction (STEMI) but is still a life-threatening complication with high mortality. Transcatheter closure of post-myocardial infarction ventricular septal defects has emerged as an alternative therapeutic approach but often requires individual strategies due to complex morphology. We report a case of a 62-year-old man who was admitted to our hospital after STEMI of the inferior wall with pulmonary congestion due to a post-myocardial infarction VSD for interdisciplinary evaluation and therapy. The patient was characterized by estimated high perioperative risk and underwent interventional closure of the VSD according to heart team decision. Because of ragged nature of the VSD closure with a conventional Occlutech™ VSD occluder was not possible. Therefore, we decided to close the defect using an off-lable device for ASD closure which was successfully implanted without relevant residual shunt.

Application of WeChat Platform in Midterm Clinical Follow-Up of Children Who Underwent Transthoracic Device Closure of VSD.

IntroductionThe purpose of this study was to investigate the feasibility and superiority of using the WeChat platform for midterm clinical follow-up of children who underwent transthoracic device closure for ventricular septal defects (VSDs).MethodsNinety children with VSDs who underwent transthoracic device closure were divided into a WeChat follow-up group (WFU group) and an outpatient follow-up group (OFU group). The patients were followed up via WeChat or at an outpatient clinic three months and one year after discharge. The incidences of adverse events, associated complications, costs and time spent, loss to follow-up rate, medication adherence, and overall satisfaction were recorded.ResultsThere was no statistically significant difference in the incidence of adverse events or postoperative complications between the two groups. Also, the loss to follow-up rate was similar between them. Compared with the OFU group, there were significant statistical advantages in the WFU group regarding the total time and cost spent, medication adherence, and satisfaction.ConclusionThe use of the WeChat platform in midterm clinical follow-up of children who underwent transthoracic device closure for VSDs has the advantages of reducing financial and time burdens, facilitating high medication adherence, and leading to high satisfaction.

Transcatheter Device Closure of a Perimembranous Ventricular Septal Defect in Congenitally Corrected Transposition of the Great Arteries

The majority of patients with congenitally corrected transposition of the great arteries, also known as transposition of the great arteries {S,L,L} have ventricular septal defects (VSD), most commonly perimembranous VSD (pmVSD). Transcatheter device closure of pmVSD in these patients has not been widely described. We present a case of device closure of pmVSD in L-TGA with an Amplatzer Duct Occluder II (ADOII) device using a deployment starting in the subpulmonary left ventricle. The case demonstrates some of the technical advantages of the ADOII device for VSD closure, specifically its low profile, symmetric shape, and soft material. These characteristics are advantageous in closing conventional pmVSD but are especially useful in patients with challenging anatomic substrates.

Procedural and Short-Term Results of Percutaneous Ventricular Septal Defect Closure in Adolescents and Adults

Procedural and Short-Term Results of Percutaneous Ventricular Septal Defect Closure in Adolescents and Adults

The Effect of Transcatheter Ventricular Septal Defect Closure on Children's Appetite, Hormones and Growth

The Effect of Transcatheter Ventricular Septal Defect Closure on Children's Appetite, Hormones and Growth

Transpercutaneous closure of perimembranous ventricular septal defects by symmatric occluder

Background: Ventricular septal defect ( VSD ) is the most frequently occurring congenital cardiac disease, accounts nearly 15-30% of all cases. Surgery is still the corrective therapy with high success and low complication but having some problems with: cardiopulmonary bypass, anesthesia, ICU, sternalitis, chest scar, AV block...&#x0D; Recently many progress in cardiac intervention applied to treat congenital heart disease especially percutaneous VSD closure. Currently patients with VSD have other choice to cure safely, effectively and less complication.&#x0D; Objectives: To evaluate 12 months rusults from transpercutaneous closure of perimembranous VSD by modified double – disk symmatric devices ( symmatric occluder).&#x0D; Methods: This is the descriptive clinical trial and follow-up.&#x0D; Result: 41 patients selected by echocardiography, 37 patients were closed successfully (90,2% success rate). No significant complication (AVB…) and 1 patient nonsignificant shunt is 2.7% after 12 month follow-up.&#x0D; Conclusions: Transpercutaneous closure of perimembranous VSD by symmatric occluder is effective and safe and more, longer follow-up.

Application value of echocardiography in transthoracic punctural closure of postoperative residual ventricular septal defect of congenital heart disease.

Residual ventricular septal defect (VSD) after congenital heart disease (CHD) is one of the major postoperative complications in cardiac surgery. At present, the commonly used clinical treatment methods for this complication are reoperation to redo surgical repair with cardiopulmonary bypass (CPB) and percutaneous transcatheter device closure, but these 2 methods have their own advantages and disadvantages. Transthoracic punctural closure of residual VSD is a feasible, safe, and novel technique for patients with residual VSD, which avoids not only the risk of difficulties in reoperation under another CPB due to thoracic adhesion, but also the risk of radiation exposure. Moreover, the operation is easier to handle due to short and direct operation path. This study aims to explore the role and value of echocardiography in transthoracic punctural closure of postoperative residual VSD of CHD. A total of 25 patients, who were admitted in the Department of Cardiovascular Surgery, Second Xiangya Hospital, Central South University and accepted transthoracic punctural closure of postoperative residual VSD, were collected. The morphology of the residual VSD and the distance from tricuspid valve and aortic valve were assessed by trans-esophageal echocardiography (TEE) preoperatively, and the location of the punctural point and the direction of puncture were determined. The establishment of delivery track and releasing of occluder device were accurately guided by TEE intraoperatively. The position and morphology of the occluder device, residual shunt, aortic regurgitaion, and outflow obstruction were required close attention in immediately postoperative evaluation. If any dislocation or residual shunt was found, adjustments were needed immediately. Follow-ups were performed at 3-5 days, 1 month, 3 months, 6 months, and 1 year after operation. Occluder location, residual shunt, valvular function, and other complications were observed by transthoracic echocardiography (TTE) to assess the effect of the closure by occluder. Ventricular size and cardiac function were determined to evaluate the state of ventricular remodeling. In addition, cardiac rhythm was monitored by ECG periodically. Of the 25 patients underwent transthoracic punctural closure of postoperative residual VSD, except 1 double outlet right ventricle (DORV) and 1 tetralogy of fallot (TOF) postoperative patients failured and immediately received a thoracotomy surgery with CPB due to excessive size of residual defect and the irregular morphology, the rest 23 patients were successfully closed by the occluders (92.0%). Among the 23 occluders (diameters range from 5 mm to 10 mm), membrane symmetrical VSD occluders were applied to 17 cases, small-waist-large-edge VSD occluder was applied to 1 case, and eccentric VSD occluders were applied to 5 cases. TEE, applied immediately after occlusion, showed the satisfactory position and the shaping of the occluders. There were no residual shunts, no cardiac tamponade, no thrombosis and outflow obstruction. Two patients had small amounts of pericardial effusion. No newly emerging valve reflux was observed. After 3-48 months of observation, there was no device displacement, newly emerging valve reflux, and residual shunt. One case had incomplete right bundle branch block. Guided by TEE, transthoracic punctural closure of postoperative residual ventricular septal defect of CHD is safe and effective. This procedure has broadened the indications for the minimally invasive treatment of CHD and improved the technical system of the minimally invasive treatment of CHD. TEE which can provide accurate diagnosis and guide the whole process plays a decisive role in this operation technique.

Aneurysm of interventricular septum: what an anaesthesiologist must know

Aneurysm of interventricular septum (IVSA) is a rare congenital anomaly. It has been documented in isolation but is seen in association with congenital heart disease in 0.3% of cases and in association with ventricular septal defect in 19% of cases. Etiologies are considered to be idiopathic formation, trauma, infection or spontaneous closure of pre-existing ventricular septal defect. Clinical manifestations are variable, some patients are asymptomatic whereas others can present with hemodynamic compromise.&#x0D; Key words: Anesthesia; Cardiac aneurysm&#x0D; Citation: Kiran S, Bansal T, Jakhar P. Aneurysm of interventricular septum: what an anesthesiologist must know. Anaesth. pain intensive care 2021;25(6):832–833;&#x0D; DOI: 10.35975/apic.v25i6.1714&#x0D;

Surgical outcomes of post-infarct ventricular septal defect repair: Insights from the UK national adult cardiac surgery audit database.

Ventricular septal defect (VSD) is becoming a progressively less frequent mechanical complication of myocardial infarction (MI). However, this event is still associated with high operative mortality. We aimed to describe the trends and the risk factors associated with surgical VSD repair outcomes and to provide a clinical benchmark for percutaneous VSD closure strategies. Using the UK National Adult Cardiac Surgery Audit database, we identified 1010 patients undergoing surgical VSD repair from 1996 to 2018. The primary outcome was operative mortality. Mixed-model, multivariable logistic regression was used to identify the risk factors associated with operative mortality taking into account the variation related to the centre, the surgeon and the year of the operation. Both the number of surgical VSD repair and the mortality rate did not change significantly over the 23-year timeframe. Operative mortality was 38.9% overall and was higher when patients were operated within the first 6 h (75%) or the first 24 h (61.3%) from the index MI. Risk factors associated with higher odds of mortality were early surgery, older age, cardiogenic shock, renal failure, previous percutaneous coronary intervention and urgent/emergent operations. Moreover, the mortality rate was similar among patients undergoing isolated VSD repair and VSD repaired combined with surgical coronary revascularization alone or with concomitant mitral valve procedures. Post MI VSD remains a dreaded mechanical complication characterized by high surgical operative mortality. A delayed operation, whenever possible, appears to be the most beneficial strategy to reduce mortality.

97 An unusual combination of rare congenital heart defects in a 70 years old lady complaining worsening dyspnea

Abstract Methods and results A 70-year-old woman presented to our outpatient clinic complaining of worsening dyspnoea in the last 3 months. She had a medical history of hypertension, diabetes, dyslipidemia, and paroxysmal atrial fibrillation. We performed a comprehensive evaluation starting with a transthoracic echocardiogram that showed a dilatation of right ventricle with normal function, severe pulmonary regurgitation, and moderate tricuspid regurgitation with estimated pulmonary artery systolic pressure of 55 mmHg; the left ventricle had normal dimension and function, with mild aortic and mitral regurgitation, and a subaortic membrane which caused a mild obstruction (maximum gradient 17 mmHg). The cardiac magnetic resonance (CMR) confirmed the enlargement of the right ventricle and of the pulmonary artery trunk (51 mm) and the severity of pulmonary regurgitation (regurgitant fraction of 41%). CMR also clearly showed the VSD just below the subaortic membrane and the left to right shunt with a jet that appeared to proceed straight from the left ventricle through the pulmonary valve (Figure 1A). The estimated Qp/Qs was 1.6 and no intramyocardial late enhancement was present. Pulmonary pressures and pulmonary vascular resistance were normal at the right heart catheterization and the Qp/Qs ratio calculated invasively was 1.45. Considering patient high-risk profile for coronary artery disease, a coronary angiography was also performed showing an abnormal origin of the right coronary artery (RCA) from the mid-portion of the left anterior descending coronary artery (LAD) with two significant stenosis: one involving the bifurcation of RCA and the other the mid-portion of the LAD (Figure 1B). The coronary computed tomography angiography (CCTA) showed a benign course of the RCA anterior to the pulmonary artery towards the auriculoventricular groove (Figure 1C, D). Taking into account all these findings, multidisciplinary heart team decided to perform a cardiac surgery intervention of pulmonary valve and trunk replacement, closure of ventricular septal defect and two coronary bypass grafts on LAD and RCA. Conclusions This case represents a combination of some rare congenital heart abnormalities where multimodality cardiovascular imaging techniques were essential to establish a proper diagnosis and to plan an adequate surgical repair. We hypothesize that the peculiar orientation of the VSD jet may have caused the pulmonary trunk dilatation considering that neither the shunt, nor the pulmonary pressure appear to have been of sufficient magnitude to cause it. Pulmonary ectasia and the damage inflicted by the jet to the cusps of the valve have led to the severe valvular insufficiency. While aortic and tricuspid regurgitation are known to be associated with VSD, to the best of our knowledge this is the first report of pulmonary regurgitation secondary to VSD.

Unplanned Surgery After Transcatheter Closure of Ventricular Septal Defect in Children: Causes and Risk Factors.

Objectives: To evaluate the causes and risk factors of unplanned surgery after transcatheter closure of ventricular septal defect (VSD) in children.Methods: A total of 773 patients with VSD who had the devices transcatheter released between January 2013 and December 2018 in our institution were retrospectively reviewed. Univariate and multivariate analyses were used to identify the risk factors for unplanned surgery.Results: Twenty four patients (3.1%) underwent unplanned surgery after transcatheter closure of VSD. The most common cause for unplanned surgery was new-onset or worsening aortic regurgitation (14/24; 58.3%), followed by occluder migration (4/24; 16.7%), complete atrioventricular block (2/24; 8.3%), severe hemolysis (2/24; 8.3%), residual shunt (1/24; 4.2%), and occluder edge near the tricuspid valve chordae (1/24; 4.2%). Logistic regression analysis revealed that primary aortic valve prolapse (OR: 5.507, 95%CI: 1.673–18.123, P = 0.005); intracristal VSD (OR: 8.731, 95%CI: 2.274–33.527, P = 0.002); eccentric occluder (OR: 4.191, 95%CI: 1.233–14.246, P = 0.022); larger occluder size (OR: 1.645, 95%CI: 1.331–2.033, P < 0.001); and pulmonary artery systolic pressure ≥45 mmHg (OR: 4.003, 95%CI: 1.073–14.941, P = 0.039) were risk factors for unplanned surgery.Conclusions: New-onset or worsening aortic regurgitation was the primary cause for unplanned surgery after transcatheter closure of VSD in children. Primary aortic valve prolapse, intracristal VSD, eccentric occluder, larger occluder size, pulmonary artery systolic pressure ≥45 mmHg could increase the risk of unplanned surgery.

Optimization of Esophageal Ultrasound under Artificial Fish Swarm Algorithm and Its Adoption in Treatment of Ventricular Septal Defect

This work was aimed at exploring the adoption value of the optimized and upgraded esophageal ultrasound in the treatment of patients with ventricular septal defect (VSD) by artificial fish swarm algorithm. A model was built based on artificial fish swarm algorithm. A random ultrasonic optical signal in the database was decomposed several times and sparsity was optimized to complete partial optimization, which was then extended to global optimization. A total of 100 patients with ventricular septal defect were divided into control group who underwent cardiopulmonary bypass under the guidance of three-dimensional thoracic ultrasound and experimental group of ventricular septal defect occlusion under the guidance of esophageal ultrasound based on artificial fish swarm algorithm. The results showed that the number of successful cases in the experimental group was 12 cases of perimembranous type, 10 cases of septal type, 7 cases of simple membranous type, 13 cases of muscular type, 4 cases of subdry type, and 2 cases of ridge type. The average length of operation after surgery was 70.65 minutes, the average length of ventilator ventilation was 125.8 minutes, and the average length of intensive care unit was 377.9 minutes. The average length of hospital stay after surgery was 5.6 days, and the average total length of hospital stay was 8.2 days, which were better than the control group in many aspects, with statistical significance ( P &lt; 0.05 ). In short, the artificial fish swarm algorithm for esophageal ultrasound-guided ventricular septal defect closure had short operation time and good postoperative effect, which was of high application value in the clinical treatment of patients with ventricular septal defect.

The In-hospital Outcome of Ventricular Septal Defect Closure and Predictor of Morbidity and Mortality at Tertiary Level Cardiac Center

Background and Aims: Factors responsible for complications and outcomes of surgical closure of ventricular septal defect differ between different cardiac centers globally. In this study, we tried to evaluate outcomes and predictors of morbidity and mortality of surgical closure of VSD in a single center. Methods: The retrospective cohort study was conducted in Shahid Gangalal National Heart Centre from 14th April 2018 to 13th April 2020. It included consecutive series of patients undergoing ventricular septal defect closure as a primary surgery Results: Out of a total 166 patients, males were 100 (60%). Adverse complications occurred on 36 (21%) with mortality of 6 (3.6%). The age ranged from 4 months to 35 years. The weight &lt;10 kgs at the time of operation had significant post-operative prolong ventilation duration (more than 6 hours) with a p value of 0.012; significant prolong ICU stays (&gt;2 days) with a p value of &lt;0.001; significant prolong hospital stay (&gt; 7 days) with a p value of &lt;0.001. The longer CPB time was associated with significantly prolonged ventilation duration (p value 0.001); significant longer ICU stay (p value 0.02). The age &lt;1 year at the time of operation had significant prolonged ICU stay; significantly prolonged hospital stays (p value of 0.033). Severe pulmonary artery hypertension (PAH) and weight up to 10 kgs at the time of operation demonstrated a trend towards association with mortality. Conclusion: Surgical VSD closure can be done with acceptable level of mortality and morbidity in our context.

Abstract 13689: The Center-Volume Effect on Congenital Heart Surgery Revised: Is It Time to Consider Regionalization of Care?

Introduction: Regionalization of congenital heart surgery (CHS) has been debated in the U.S. and other countries. Previous reports demonstrated a variable effect of a center’s volume on in-hospital postoperative mortality. However, the volume-outcome relationship for CHS remains incompletely understood without considering outcomes beyond hospital discharge. Hypothesis: We sought to determine, whether procedure-specific center volume predicts postoperative mortality for infants undergoing three complex benchmark procedures (Norwood procedure, arterial switch operation and complete atrioventricular canal repair) and used ventricular septal defect (VSD) closure as a simple benchmark procedure comparison. Methods: We used data from the Pediatric Cardiac Care Consortium, a multi-center U.S.-based clinical registry of CHS, enriched with post-discharge death data after linkage with the National Death Index. We used generalized estimating equations to assess the association between procedure-specific volume and mortality from the time of CHS and up to three years after CHS. Models were adjusted for patient age and weight at CHS, presence of a chromosomal abnormality, and surgical era and accounted for clustering at the center-level. Results: Analysis included 6,656 infants operated at 42 centers between 1982 and 2003. We found an absolute reduction in post-operative risk of death ranging from 6-12% for every additional surgery performed in the same center for Norwood, ASO, and CAVC repair and at all time points examined (Table). There was no statistically significant association between VSD center volume and mortality at any time point. Conclusions: In-hospital and longer-term survival after infantile CHS is improved with increased center case volume for complex CHS. These findings support the regionalization of complex CHS in the U.S.. Decision-makers should consider feasibility of such regionalization to improve outcomes after complex CHS.