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Shallow suture at ventricular septal defect may safely reduce right bundle branch block

Published online by Cambridge University Press:  27 July 2023

Dae Hyeon Kim
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University, College of Medicine, Seoul, Republic of Korea
Sungkyu Cho
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University, College of Medicine, Seoul, Republic of Korea
Woong-Han Kim
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University, College of Medicine, Seoul, Republic of Korea
Hye Won Kwon
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University, College of Medicine, Seoul, Republic of Korea
Mi Kyoung Song
Affiliation:
Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University, College of Medicine, Seoul, Republic of Korea
Jae Gun Kwak*
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University, College of Medicine, Seoul, Republic of Korea
*
Corresponding author: J. G. Kwak; Email: switch.surgeon@gmail.com

Abstract

Background:

To avoid rhythm disturbance, sutures for ventricular septal defect closure have been traditionally placed 2∼5 mm or more away from the edge of the ventricular septal defect. However, the traditional suturing method appears to induce right bundle branch block and tricuspid valve regurgitation after ventricular septal defect closure more than our alternative technique, shallow suturing just at the edge of the ventricular septal defect (shallower bites at the postero-inferior margin). We aimed to verify our clinical experience of perimembranous ventricular septal defect repair.

Methods:

The alternative shallow suturing method has been applied since 2003 at our institution. We retrospectively reviewed the clinical data of 556 isolated perimembranous ventricular septal defect patients who underwent surgical closure from 2000 to 2019. We investigated the postoperative occurrence of right bundle branch block or progression of tricuspid regurgitation and analysed risk factors for right bundle branch block and tricuspid regurgitation.

Results:

Traditional suturing method (Group T) was used in 374 cases (66.8%), and alternative suturing method (Group A) was used in 186 cases (33.2%). The right bundle branch block occurred more frequently in Group T (39.6%) than in Group A (14.9%). In multivariable logistic regression analysis, Group T and patch material were significant risk factors for late right bundle branch block. More patients with progression of tricuspid regurgitation were found in Group T.

Conclusions:

Shallow suturing just at the edge of the ventricular septal defect may reduce the rate of right bundle branch block occurrence and tricuspid regurgitation progression without other complications.

Type
Original Article
Copyright
© The Author(s), 2023. Published by Cambridge University Press

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References

Meijboom, F, Szatmari, A, Utens, E, et al. Long-term follow-up after surgical closure of ventricular septal defect in infancy and childhood. J Am Coll Cardiol 1994; 24: 13581364.10.1016/0735-1097(94)90120-1CrossRefGoogle ScholarPubMed
Schipper, M, Slieker, MG, Schoof, PH, Breur, JM. Surgical repair of ventricular septal defect; contemporary results and risk factors for a complicated course. Pediatr cardiol 2017; 38: 264270.10.1007/s00246-016-1508-2CrossRefGoogle ScholarPubMed
Aydemir, NA, Harmandar, B, Karaci, AR, et al. Results for surgical closure of isolated ventricular septal defects in patients under one year of age. J Cardiac Surg: Includ Mechanic Biological Supp Heart and Lungs 2013; 28: 174179.CrossRefGoogle ScholarPubMed
Lee, JH, Cho, S, Kwak, JG, et al. Tricuspid valve detachment for ventricular septal defect closure in infants< 5 kg: should we be hesitant? Eur J Cardio Thorac Surg 2021; 60: 544551.CrossRefGoogle ScholarPubMed
Kouchoukos, N, Blackstone, E, Hanley, F, et al. Ventricular septal defect. Kirklin/Barratt-Boyes Cardiac Surg 2003; 2: 12741325.Google Scholar
McCarthy, K, Ho, SY, Anderson, RH. Categorisation of ventricular septal defects: review of the perimembranous morphology. Images Paediatr Cardiol 2000; 2: 2440.Google ScholarPubMed
Titus, JL, Daugherty, GW, Edwards, JE. Anatomy of the atrioventricular conduction system in ventricular septal defect. Circulation 1963; 28: 7281.10.1161/01.CIR.28.1.72CrossRefGoogle ScholarPubMed
Jonas, R. Comprehensive Surgical Management of Congenital Heart Disease. CRC Press, New York, 2002, pp. 247250.CrossRefGoogle Scholar
Varghese, R, Saheed, S, Ravi, AK, Sherrif, EA, Agarwal, R, Kothandam, S. The, excluding, suture technique for surgical closure of ventricular septal defects: a retrospective study comparing the standard technique. Ann Pediatr Cardiol 2016; 9: 229–35.CrossRefGoogle ScholarPubMed
Surawicz, B, Childers, R, Deal, BJ, Gettes, LS. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American heart association electrocardiography and arrhythmias committee, council on clinical cardiology; the American college of cardiology foundation; and the heart rhythm society: endorsed by the international society for computerized electrocardiology. Circulation 2009; 119: e235e240.10.1161/CIRCULATIONAHA.108.191095CrossRefGoogle Scholar
Zoghbi, WA, Enriquez-Sarano, M, Foster, E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography. J Am Soc Echocardiogr 2003; 16: 777802.CrossRefGoogle ScholarPubMed
Yoshitake, S, Kaneko, Y, Morita, K, et al. Visualization and quantification of the atrioventricular conduction axis in hearts with ventricular septal defect using phase contrast computed tomography. J Thorac Cardiovasc Surg 2020; 160: 490496.10.1016/j.jtcvs.2020.02.036CrossRefGoogle ScholarPubMed
Tucker, EM, Pyles, LA, Bass, JL, Moller, JH. Permanent pacemaker for atrioventricular conduction block after operative repair of perimembranous ventricular septal defect. J Am Coll Cardiol 2007; 50: 11961200.CrossRefGoogle ScholarPubMed
Hobbins, SM, Izukawa, T, Radford, DJ, Williams, WG, Trusler, GA. Conduction disturbances after surgical correction of ventricular septal defect by the atrial approach. Heart 1979; 41: 289293.CrossRefGoogle ScholarPubMed
Fukuda, T, Suzuki, T, Kashima, I, Sato, M, Morikawa, Y. Shallow stitching close to the rim of the ventricular septal defect eliminates injury to the right bundle branch. Ann Thorac Surg 2002; 74: 550555.CrossRefGoogle Scholar
Sabiston, DC, Sellke, FW, Del Nido, PJ, Sabiston, Swanson SJ. Sabiston & Spencer Surgery of the Chest. Saunders/Elsevier, Philadelphia, 2010, pp. 18531857.Google Scholar
Desai, MH, Hachana, S, Bukhari, SM, et al. A comparison of autologous pericardium with DacronTM for closure of ventricular septal defect in infants. Eur J Cardio Thorac 2022; 62: ezac022.10.1093/ejcts/ezac022CrossRefGoogle Scholar
Kalfa, D, Ghez, O, Kreitmann, B, Metras, D. Secondary subaortic stenosis in heart defects without any initial subaortic obstruction: a multifactorial postoperative event. Eur J Cardio Thorac 2007; 32: 582587.CrossRefGoogle ScholarPubMed
Fleg, JL, Das, DN, Lakatta, EG. Right bundle branch block: long-term prognosis in apparently healthy men. J Am Coll Cardiol 1983; 1: 887892.10.1016/S0735-1097(83)80204-6CrossRefGoogle ScholarPubMed
Pedersen, TA, Andersen, NH, Knudsen, MR, Christensen, TD, Sørensen, KE, Hjortdal, VE. The effects of surgically induced right bundle branch block on left ventricular function after closure of the ventricular septal defect. Cardiol Young 2008; 18: 430436.CrossRefGoogle ScholarPubMed
Heiberg, J, Eckerström, F, Rex, CE, et al. Heart rate variability is impaired in adults after closure of ventricular septal defect in childhood: a novel finding associated with right bundle branch block. Int J Cardiol 2019; 274: 8892.CrossRefGoogle ScholarPubMed
Heiberg, J, Redington, A, Hjortdal, VE. Exercise capacity and cardiac function after surgical closure of ventricular septal defect—is there unrecognized long-term morbidity? Int J Cardiol 2015; 201: 590594.10.1016/j.ijcard.2015.08.166CrossRefGoogle Scholar
Bussink, BE, Holst, AG, Jespersen, L, Deckers, JW, Jensen, GB, Prescott, E. Right bundle branch block: prevalence, risk factors, and outcome in the general population: results from the Copenhagen city heart study. Eur Heart J 2013; 34: 138146.10.1093/eurheartj/ehs291CrossRefGoogle ScholarPubMed
Fernández-Lozano, I, Brugada, J. Right bundle branch block: are we looking in the right direction? Eur Heart J 2013; 34.2: 8688.10.1093/eurheartj/ehs359CrossRefGoogle Scholar
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