The "excluding" suture technique for surgical closure of ventricular septal defects: A retrospective study comparing the standard technique.
BACKGROUND
Conventional methods of closure of ventricular septal defects involve placement of sutures 4-5 mm from the posterior inferior margin. This study compares the conventional method with an alternative technique wherein sutures are placed along the edge of the defect thereby "excluding" the conduction system and the tensor apparatus of the tricuspid valve from the suture line.


METHODS
Between January 2013 and January 2016, 409 consecutive patients were retrospectively reviewed and divided into two matched groups. Group A (n = 174) underwent closure using the alternative technique and Group B (n = 235) with the conventional technique. Patients with isolated ventricular septal defects (VSDs) (n = 136) were separately analyzed as were infants within this subset.


RESULTS
Immediate postoperative results were similar with no statistically significant differences in either group in terms of incidence of residual defects or postoperative tricuspid regurgitation. There was however a significantly increased incidence of post operative complete heart block (CHB) among patients in the conventional group (P = 0.02). Incidence of temporary heart block that reverted to sinus rhythm was also more in the conventional method group (Group B) (P = 0.03) as was right bundle branch block (P ≤ 0.05) in all the subsets of patients analyzed.


CONCLUSIONS
Surgical closure of VSDs can be accomplished by placing sutures along the margins or away with comparable results. The incidence of CHB, however, seems to be less when the "excluding" technique is employed.
Department of Pediatric Cardiac Surgery, Madras Medical Mission, Chennai, Tamil Nadu, India.
Roy
R
Varghese
Department of Pediatric Cardiac Surgery, Madras Medical Mission, Chennai, Tamil Nadu, India.
Sanni
S
Saheed
Department of Pediatric Cardiac Surgery, Madras Medical Mission, Chennai, Tamil Nadu, India.
Amrutha K
AK
Ravi
Department of Pediatric Cardiac Surgery, Madras Medical Mission, Chennai, Tamil Nadu, India.
Ejaz Ahmed
EA
Sherrif
Department of Pediatric Cardiac Surgery, Madras Medical Mission, Chennai, Tamil Nadu, India.
Ravi
R
Agarwal
Department of Cardiology, Madras Medical Mission, Chennai, Tamil Nadu, India.
Sivakumar
S
Kothandam
Congenital heart disease; ventricular septal defect; ventricular septal defect closure