Risk Factors for Major Adverse Events after Surgical Closure of Ventricular Septal Defect in Patients Less than 1 Year of Age: A Single-Center Retrospective.

OBJECTIVE: To reveal the risk factors that can lead to a complicated course and an increased morbidity in patients < 1 year old after surgical ventricular septal defect (VSD) closure. METHODS: We reviewed a consecutive series of patients who were admitted to our institution for surgical VSD closure who were under one year of age, between 2015 and 2018. Mechanical ventilation (MV) time > 24 hours, intensive care unit (ICU) stay longer than three days, and hospital stay longer than seven days were defined as "prolonged". Unplanned reoperation, complete heart block requiring a permanent pacemaker implantation, sudden circulatory arrest, and death were considered as significant major adverse events (MAE). RESULTS: VSD closure was performed in 185 patients. The median age was five (1-12) months. There was prolonged MV time in 54 (29.2%) patients. Four patients (2.2%) required permanent pacemaker implantation. Hemodynamically significant residual VSD was observed in six (3.2%) patients. Extracorporeal membrane oxygenation-cardiopulmonary resuscitation was performed in one (0.5%) patient. Small age (< 4 months) (P-value<0.001) and prolonged cardiopulmonary bypass time (P=0.03) were found to delay extubation and to prolong MV time. Low birth weight at the operation was associated with MAE (P=0.03). CONCLUSION: Higher body weight during operation had a reducing effect on the MAE frequency and shortened the MV duration, ICU stay, and hospital stay. As a conclusion, for patients who are scheduled to undergo VSD closure, body weight should be taken into consideration.

Risk factors for major adverse events after surgical closure of ventricular septal defect in patients less than 1 year of age: a single-center retrospective

Abstract Objective: To reveal the risk factors that can lead to a complicated course and an increased morbidity in patients < 1 year old after surgical ventricular septal defect (VSD) closure. Methods: We reviewed a consecutive series of patients who were admitted to our institution for surgical VSD closure who were under one year of age, between 2015 and 2018. Mechanical ventilation (MV) time > 24 hours, intensive care unit (ICU) stay longer than three days, and hospital stay longer than seven days were defined as "prolonged". Unplanned reoperation, complete heart block requiring a permanent pacemaker implantation, sudden circulatory arrest, and death were considered as significant major adverse events (MAE). Results: VSD closure was performed in 185 patients. The median age was five (1-12) months. There was prolonged MV time in 54 (29.2%) patients. Four patients (2.2%) required permanent pacemaker implantation. Hemodynamically significant residual VSD was observed in six (3.2%) patients. Extracorporeal membrane oxygenation-cardiopulmonary resuscitation was performed in one (0.5%) patient. Small age (< 4 months) (P-value<0.001) and prolonged cardiopulmonary bypass time (P=0.03) were found to delay extubation and to prolong MV time. Low birth weight at the operation was associated with MAE (P=0.03). Conclusion: Higher body weight during operation had a reducing effect on the MAE frequency and shortened the MV duration, ICU stay, and hospital stay. As a conclusion, for patients who are scheduled to undergo VSD closure, body weight should be taken into consideration.

Ruptura del septum ventricular como complicación de un evento coronario agudo / Ventricular septal rupture complicating acute myocardial infarction

Resumen La ruptura del septum ventricular (RSV) es una complicación mecánica infrecuente del infarto agudo de miocardio (IAM). Los principales factores de riesgo descritos son la edad avanzada, el género femenino, un primer episodio de IAM y la presencia de enfermedad coronaria. Se sospecha de esta patología cuando clínicamente se evidencia un deterioro inexplicable del estado hemodinámico posterior al infarto. Los estudios imagenológicos (ecocardiograma y Doppler color) ayudan a confirmar el diagnóstico de RSV. Respecto al manejo, la corrección quirúrgica continúa siendo el pilar del tratamiento, ya que posee menor mortalidad en comparación con el abordaje médico no quirúrgico. Se presentan dos casos de ruptura del septum ventricular; el primero corresponde a una paciente femenina adulta mayor, con múltiples comorbilidades, quien desarrolló un síndrome coronario agudo tipo infarto agudo de miocardio con elevación del segmento ST a nivel anteroseptal. Se le realizó angioplastia primaria con evidencia de ruptura del septum ventricular, que fue corregida mediante cirugía de forma temprana. Pasadas veinticuatro horas, presentó ruptura de la pared libre del ventrículo izquierdo, hecho que precipitó su deceso. El segundo caso es una paciente femenina adulta mayor, quien presentó síndrome coronario agudo tipo infarto agudo de miocardio sin elevación del ST en cara lateral. Siete días después se documentó la existencia de la ruptura del septum ventricular, la cual fue corregida de manera tardía, en el día octavo, sin complicaciones asociadas.

Abstract Ventricular septal rupture (VSR) is a rare mechanical complication of acute myocardial infarction (AMI). The main risk factors described are advanced age, female gender, a first episode of AMI and presence of coronary disease. There is suspicion for this condition when clinical evidence shows unexplained deterioration of hemodynamic status following infarction. Imaging studies (echocardiogram and colour Doppler) help confirm the diagnosis of ventricular septal rupture. Regarding management, surgical correction continues to be the mainstay of treatment, as it poses lower mortality in comparison to nonsurgical medical approach. Two cases of VSR are presented, the first one is a female adult patient with multiple comorbidities who developed an acute coronary syndrome of a acute myocardial infarction with an anteroseptal ST segment elevation. Primary angioplasty was performed that evidenced ventricular septal rupture, which was surgically corrected at an early stage. After 24 hours, patient showed left ventricular free wall rupture, which precipitated her death. Second case is a female old patient who presented acute acute coronary syndrome of a acute myocardial infarction without lateral ST segment elevation. Seven days later a ventricular septal rupture was documented, which was corrected at a later stage on the eighth day without associated complications.