Open Access

ARTICLE

Surgical Repair of Ventricular Septal Defect in Neonates: Indications and Outcomes

by Jae Hong Lee¹, Sungkyu Cho^2,*, Jae Gun Kwak², Hye Won Kwon², Woong-Han Kim², Mi Kyoung Song³, Sang-Yun Lee³, Gi Beom Kim³, Eun Jung Bae³

1 Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
2 Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul, Korea
3 Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, Korea

* Corresponding Author: Sungkyu Cho. Email:

Congenital Heart Disease 2024, 19(1), 69-83. https://doi.org/10.32604/chd.2024.045137

Received 18 August 2023; Accepted 23 January 2024; Issue published 20 March 2024

Abstract

Background: The optimal surgical timing and clinical outcomes of ventricular septal defect (VSD) closure in neonates remain unclear. We aimed to evaluate the clinical outcomes of VSD closure in neonates (age ≤ 30 days). Methods: We retrospectively reviewed 50 consecutive neonates who underwent VSD closure for isolated VSDs between August 2003 and June 2021. Indications for the procedure included congestive heart failure/failure to thrive and pulmonary hypertension. Major adverse events (MAEs) were defined as the composite of all-cause mortality, reoperation, persistent atrioventricular block, and significant (≥grade 2) valvular dysfunction. Results: The median age and body weight at operation were 26.0 days (interquartile range [IQR], 18.8–28.3) and 3.7 kg (IQR, 3.3–4.2), respectively. The median follow-up duration was 110.4 months (IQR, 56.8–165.0). Seven patients required preoperative respiratory support, and five had significant (≥grade 2) preoperative valvular dysfunction. One early mortality occurred due to irreversible cardiogenic shock; no late mortality was observed. One reoperation was due to hemodynamically significant residual VSD at 103.8 months postoperatively. The overall survival, freedom from reoperation, and freedom from MAE at 15-years were 98.0%, 96.3%, and 94.4%, respectively. Preoperative mechanical ventilation was associated with a longer duration of postoperative mechanical ventilation (p < 0.001) and a longer length of intensive care unit stay (p < 0.001). Conclusions: VSD closure with favorable outcomes without morbidities is feasible even in neonates. However, neonates requiring preoperative respiratory support may require careful postoperative management considering the long-term postoperative risks. Overall, surgical VSD closure might be indicated earlier in neonates with respiratory compromise.

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Keywords

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