Surgical closure of ventricular septal defect: Contemporary results and risk factors for electrophysiological changes.

Background: The surgical closure of a ventricular septal defect (VSD) is a commonly performed procedure. Postoperative
ECG changes are common findings that need a proper assessment to provide valuable insights into the outcomes of the
patients. In this study, we investigate the potential risk factors associated with electrophysiological changes following
surgical closure of VSD.
Patients and Methods: A prospective, nonrandomized study was conducted from October 2020 to December 2022 on
patients scheduled for VSD closure. Patients with prior abnormal congenital electrophysiological disturbances, internal
pacemaker, Ebstein’s anomaly, associated subaortic membrane or hypertrophic obstructive cardiomyopathy, iatrogenic
VSD, and need aortic root dilatation with VSD closure were excluded. 12-lead ECG was reported on ICU admission
and daily after that till discharge. Various demographic and perioperative data were recorded, and their correlation to the
presence of electrophysiological changes and outcomes were analyzed.
Results: Two hundred patients who underwent surgical VSD closure were included. Arrhythmias occurred in 41 (20.5%)
patients. The encountered arrhythmias were sinus bradycardia with junctional escape in 24 patients, junctional ectopic
tachycardia in 10 patients, supraventricular tachycardia in two patients, premature complex in two patients, second-degree
heart block in four patients, and third-degree block in two patients. Mother’s hypertension, preoperative mechanical
ventilation, associated cardiac anomalies, Down syndrome, size of VSD, type of VSD, total bypass time, aortic crossclamp
time, concomitant procedures, intraoperative pacing, and residual VSD were identified in univariate analysis as
risk factors for occurrence of arrhythmias.
Conclusion: Surgical VSD closure is a safe procedure with low mortality and morbidity rates. Younger age and lower
body weight are risk factors for prolonged hospitalization, ICU stay, and mechanical ventilation. Longer cross-clamp and
cardiopulmonary bypass times were significant predictors of postoperative ECG changes and associated complications
with prolonged ICU and hospital stay.