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).