Conduction system disorders after surgical patch closure of ventricular septal defects; a comparison between two suturing techniques

Abdallah Nosair; Mohamed Elkahely; Rezk Abu-Gamila

doi:10.35810/ects.v1i4.87

Abdallah Nosair Cardiothoracic Surgery Department, Faculty of Medicine, Cairo University, Giza, Egypt
Mohamed Elkahely Department of Cardiothoracic Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
Rezk Abu-Gamila Department of Cardiothoracic Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt

DOI: https://doi.org/10.35810/ects.v1i4.87

Keywords: Conduction disorders, Cardiac arrhythmia, Ventricular septal defect, Complete heart block

Abstract

Background: Ventricular septal defect (VSD) is the most common congenital heart disease, and conduction disorder is one of the frequent complications after VSD closure. Suturing technique used for VSD closure may affect the occurrence of this complication. The aim of this study was to compare the outcome of VSD surgical patch closure using continuous versus interrupted suture techniques.

Methods: The study included 150 VSD patients who had surgical patch closure between December 2014 and March 2017. They were subclassified into two groups according to the suture technique; continuous suture technique (n= 75) and interrupted suture technique (n= 75). Preoperative, operative, and postoperative variables were reviewed and analyzed. The postoperative rhythm was recorded using contіnuous electrocardiogram during intensive care unit stay. 12-leads electrocardiogram and echocardiography were performed immediately after surgery and repeated before discharge and after 3, 6, 12 months then yearly. The follow-up period ranged from 1 to 3.25 years (2.04 ± 0.84 years).

Results: Aortіc cross-clamp tіme was longer in the interrupted technique group (51.40±15.21 vs. 42.32±13.86 minutes; p <0.01). 7 (9.3%) patients in the continuous technique group had an atrioventricular block during ICU stay, and 2 (2.7 %) had complete heart block. However, one patient (1.3%) in the interrupted technique group had an atrioventricular block, and no patient had complete heart block (p=0.006). Incidence of conduction defects during follow-up was insignificantly different between the groups. There was no significant difference in the postoperative complications between the groups.

Conclusions: Complete heart block is an infrequent complication after VSD patch closure. The interrupted suture technique was associated with a lower incidence of conduction defects during the early postoperative period