A Retrospective Survey Comparing Suture Techniques Regarding the Risk of Permanent Epicardial Pacemaker Implantation After Ventricular Septal Defect Closure

• Published in: Revista brasileira de cirurgia cardiovascular Vol. 33; no. 4; pp. 339 - 346
• Main Authors: Ayık, Mehmet Fatih, Şişli, Emrah, Dereli, Münevver, Şahan, Yasemin Özdemir, Şahin, Hatice, Levent, Reşit Ertürk, Atay, Yüksel
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Cirurgia Cardiovascular 01-01-2018
• Subjects: Adolescent; Adult; Age Distribution; CARDIAC & CARDIOVASCULAR SYSTEMS; Cardiac Pacing, Artificial - methods; Cardiac Pacing, Artificial - statistics & numerical data; Cardiology; Child; Child, Preschool; Defects; Electrocardiography; Female; Heart Block; Heart Block - etiology; Heart Block - therapy; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Heart Septal Defects, Ventricular - complications; Heart Septal Defects, Ventricular - surgery; Heart surgery; Humans; Infant; Infant, Newborn; Logistic Models; Male; Middle Aged; Original; Pacemaker, Artificial; Pacemaker, Artificial - statistics & numerical data; Pediatrics; Pulmonary arteries; Reproducibility of Results; Retrospective Studies; Risk Factors; Statistics, Nonparametric; SURGERY; Suture Technique; Suture Techniques - statistics & numerical data; Time Factors; Treatment Outcome; Veins & arteries; Weaning; Young Adult; Heart Block; Heart Defects, Congenital; Suture Technique; Pacemaker, Artificial; Heart Septal Defects, Ventricular
• ISSN: 1678-9741; 0102-7638; 1678-9741
• DOI: 10.21470/1678-9741-2018-0010

The aim of this study is to compare the continuous and combined suturing techniques in regards to the needing epicardial pacing at the time of weaning from cardiopulmonary bypass (EP-CPB) and to evaluate permanent epicardial pacemaker (PEP) implantation in patients who had undergone surgical ventricular septal defect (VSD) closure.
This single-centre retrospective survey includes 365 patients who had consecutively undergone VSD closure between January 2006 and October 2015.
The median age and weight of the patients were 15 months (range 27 days - 56.9 years) and 10 kg (range 3.5 - 100 kg), respectively. Continuous and combined suturing techniques were utilised in 302 (82.7%) and 63 (17.3%) patients, respectively. While 25 (6.8%) patients required EP-CPB, PEP was implanted in eight (2.2%) patients. Comparison of the continuous and combined suturing techniques regarding the need for EP-CPB (72% vs. 28%, P=0.231) and PEP implantation (87.5% vs. 12.5%, P=1.0) were not statistically significant. The rate of PEP implantation in patients with perimembraneous VSD without extension and perimembraneous VSD with inlet extension did not reveal significant difference between the suture techniques (P=1.0 and P=0.16, respectively). In both univariate and multivariate analyses, large VSD (P=0.001; OR 8.63; P=0.011) and perimembraneous VSD with inlet extension (P<0.001; OR 9.02; P=0.005) had a significant influence on PEP implantation.
Both suturing techniques were comparable regarding the need for EP-CPB or PEP implantation. Caution should be exercised when closing a large perimembraneous VSD with inlet extension.