[Prognostic factors associated with postoperative morbidity in children with isolated ventricular septal defect]

Rev Med Inst Mex Seguro Soc. 2015;53 Suppl 3:S324-35.
[Article in Spanish]

Abstract

Background: Isolated ventricular septal defect (VSD) is one of the most common congenital heart diseases worldwide. Prognostic factors associated with postoperative morbidity in patients with isolated VSD in the Hospital de Pediatría del Centro Médico Nacional Siglo XXI have not been identified.

Methods: A retrospective cohort study was conducted from January 1, 2009 to December 31, 2013. Descriptive statistics and comparisons between groups were performed using chi-square test, Mann Whitney U test and linear regression. Relative risks (RR) and 95 % confidence intervals (95% CI) were calculated.

Results: A total of 64 patients who underwent isolated VSD closure were included, 12.5 % (n = 8) had a history of pulmonary banding and 22 patients (34.3 %) had Down syndrome. The perimembranous and subaortic lesions occurred in 70 % of cases. Factors associated with an increased morbidity and a prolonged intensive care unit (ICU) stay were: lactate at the end of extracorporeal circulation (ECC) greater than 3 mmol/L (p = 0.02) and Down syndrome (p = 0.02), who had the highest incidence of postoperative complications (p = 0.02).

Conclusions: A statistically significant association was found: the higher the preoperative functional class, the longer the hospital stay, the number of days at ICU and the hours of mechanical ventilation.

Introducción: la comunicación interventricular aislada (CIV) es una de las cardiopatías congénitas más frecuentes a nivel mundial. Se desconoce cuáles son los factores pronósticos asociados a la morbilidad postoperatoria de los pacientes con CIV aislada en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI. Métodos: se realizó un estudio de cohorte retrospectivo del 1 de enero de 2009 al 31 de diciembre de 2013. Se utilizó estadística descriptiva y comparaciones entre los grupos mediante chi cuadrada, U de Mann Whitney y regresión lineal. Se calcularon riesgos relativos (RR) e intervalos de confianza al 95 % (IC 95%). Resultados: se incluyeron 64 pacientes a quienes se les realizó cierre de comunicación interventricular aislada. El 12.5 % (n = 8) tenían antecedente de cerclaje pulmonar y 22 (34.3 %) pacientes tenían síndrome de Down. Las CIV perimembranosas y la subaórtica se presentaron en 70 % de los casos. Los factores asociados a una mayor morbilidad y estancia prolongada en terapia intensiva fueron: lactato al final de la circulación extracorpórea (CEC) mayor a 3mmol/L (p = 0.02) y el síndrome de Down (p = 0.02) quienes presentaron una mayor frecuencia de complicaciones postoperatorias (p = 0.02). Conclusiones: se encontró una asociación estadísticamente significativa: cuanto mayor era la clase funcional preoperatoria, mayor era su estancia intrahospitalaria, con mayor número de días en terapia intensiva y mayor tiempo de ventilación mecánica asistida.

Keywords: Congenital heart defects; Down syndrome; Operative surgical procedures; Pediatrics; Ventricular heart septal defects.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Heart Septal Defects, Ventricular / surgery*
  • Humans
  • Infant
  • Infant, Newborn
  • Linear Models
  • Male
  • Postoperative Complications / diagnosis
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology*
  • Prognosis
  • Retrospective Studies
  • Risk Factors