Results
A total of 108 patients underwent surgical ventricular septal defect
closure during the study period. Their demographic characteristics are
presented in Table 1. Their median age at operation was 11.5 months
(range, 1.5–156 months). Of the patients, 61 (56.5%) were male and 47
(43.5%) were female. The median body weight of the patients was 7 kg
(range, 3.2–60 kg) at the time of operation. The most common defect was
perimembranous ventricular septal defect (n = 90, 83.3%), followed by
infundibular ventricular septal defect (n = 16, 14.9%) and muscular
ventricular septal defect (n = 2, 1.9%). The most frequent concomitant
cardiac defects were patent ductus arteriosus (n = 42, 38.9%) and
atrial septal defect (n = 31, 28.7%). Genetic anomalies were present in
17 patients (15.7%); the most common genetic anomaly was Down syndrome
(n = 11, 10.2%). Of all the patients, 13.9% (n = 15) had undergone
pulmonary artery banding prior to the ventricular septal defect repair.
The mean cardiopulmonary bypass time was 61 ± 17 minutes (range, 20–109
minutes). The mean aortic cross-clamp time was 46 ± 15 minutes (range,
16–87 minutes).
Table 2 summarizes the examined complications and outcomes. The median
(range) MV duration, PICU stay, and hospital stay of the patients were 2
hours (1–56 hours), 3 days (1–34 days), and 5 days (2–66 days),
respectively. Prolonged MV occurred in 11 patients (10.2%); prolonged
PICU stay, in 65 patients (60.2%); and delayed discharge, in 37
patients (34.3%). Pulmonary complications such as atelectasis and
pleural effusion requiring chest tube placement were the most frequent
(n = 8, 7.4%), followed by acute kidney injury (n = 6, 5.6%) and heart
rhythm problems (n = 4, 3.7%) such as transient atrioventricular block
and junctional ectopic tachycardia. In the patients with pleural
effusion, the fluid was serous. None of the patients died, had a
significant residual defect, and had a persistent heart block requiring
placement of a permanent pacemaker. One patient experienced a major
adverse event (sudden cardiac arrest). The patient with genetic
syndromes had a significant congestive heart failure preoperatively. In
addition, the body weight during the operation was 3,400 g.
The effects of genetic syndrome are presented in Table 3. The patients
with genetic syndromes had statistically longer MV times (p <
0.001), PICU stay (p < 0.001), and hospital stay (p = 0.002).
The univariate analysis results are shown in Table 3. In the analysis,
while the PICU hospitalization stay, hospitalization duration, and MV
duration were longer in the patients with complications, their ages and
weights were lower and initiation times of nutritional therapy were
later. The patients with prolonged PICU stay, hospital stay, and MV
duration had similar chacteristics to those with complications but had
lower ages and weights and later initiation times of nutritional
therapy. In the patients with prolonged hospitalization, the PIM-2
score, PRISM score, and MV duration were also longer. In addition, the
PRISM score was higher in the patients who needed prolonged MV. The
results of the ROC analysis performed to determine the effects of age
and weight, and the cutoff values for the development of complications
are shown in Figure 1. The area under the curve was 0.76 for age and
0.76 for body weight. The cutoff age of 5 months had 76% sensitivity
and 71% specificity, and the cutoff weight of 5.8 kg had 74%
sensitivity and 71% specificity.
A multivariable model was used to assess the association between a
patient’s characteristics and prolonged MV time, or prolonged PICU or
hospital stay (Table 4). Prolonged PICU stay was associated with MV time
of patients (odds ratio [OR], 0.9; 95% confidence interval
[CI], -1.22–3.03; p < 0.001), and nutritional therapy
time (OR, 0.05; 95% CI, 0.01–0.1; p = 0.044). Prolonged hospital stay
was associated with MV time of patients (OR, 0.6; 95% CI, 0.44–0.74; p
< 0.001). Prolonged MV time was associated with nutritional
therapy time (OR, 0.25; 95% CI, 0.13–0.35; p < 0.001) and,
PRISM score (OR, 0.43; 95% CI, 0.16–0.7; p = 0.002).