Results
The mean CPB time was 98 ± 31 minutes (34-175), and the ACC time was
70.13 ± 25 minutes (89-140). While the mean drainage amount was 427 ±
409 ml (10-2200), the blood product amount used was 597.41±444.36 ml
(0-2750).
The number of moderate and severe postoperative LAVV regurgitation was
determined to be 15 and 1, respectively, and right atrio-ventricular
(AV) valve regurgitation was found to be 10 and 0, respectively.VSD
creating a slightly shunt was observed in one postoperative patient.
The mean intubation time was 75.09 ± 108.47 hours (4 – 456), the length
of intensive care stay was 7.82 ± 7.46 days (1-31), and the total length
of hospital stay was 17.14±15.63 days (4-90).
(Table 3)
Of 7 patients with rhythm problems, 4 patients (7.1%) had complete AV
block, 2 (3.5%) had Junction Ectopic Tachycardia (JET), and 1 patient
had Right Bundle Branch Block (RBBB).
A permanent pacemaker was implanted in patients with complete block.
While two patients were treated for tamponade and 4 patients for
chylothorax, a pericardial tube was placed in 1 patient remaining in the
long term with a diagnosis of Dressler’s syndrome and a peritoneal
dialysis catheter was inserted in 8 patients. Twelve patients used
long-term antibiotherapy due to postoperative pneumonia and 2 patients
due to urinary infection. One patient was treated with the diagnosis of
sepsis, and one patient was treated with the diagnosis of an epileptic
attack. NO2 inhalation therapy was applied to 4 patients
due to high pulmonary pressure. (Table 4)
While the median of age of patients who underwent MSP was 7,5 months,
the distribution of patients who underwent TPT was concentrated over 14
months (p=0.003). In the comparison of females and males in both groups,
it was observed that there were significantly more female patients in
the MSP group (p=0.023). When the VSD diameter between both techniques
was compared by the Mann-Whitney U test, the mean rank was observed to
be 8,2 mm in MSP and 13,78 mm in TPT (p=0.000) (Graph 1). While there
was no difference between left atrioventricular valve repair, the right
atrioventricular valve repair was observed to be significantly more
(p=0.043) in the MSP technique.
When CPB time was compared, according to the independent samples t-test
result, the mean and standard deviation was 125.3 and 27.3 respectively
in TPT, and the mean and standard deviation was found to be 83.4 and
23.8, respectively in MSP (Graph 2). Likewise, ACC time was compared,
and mean and standard deviation was determined to be 88.6 and 23.5
respectively in TPT, and 60.1 and 22.3 respectively in MSP (Graph 3).
According to these results, both CPB and ACC time was significantly
longer in the TPT.
The comparison of postoperative LAVV regurgitation was performed with
the chi-square test, and the moderate-severe group was observed
statistically significantly less in the MSP technique (p=0.016). The
amount of drainage was compared by the Mann-Whitney U test, and the mean
rank and arithmetic mean were found to be 36.5 and 603 respectively in
TPT, and 23.5 and 334 respectively in MSP. These values make the
excessive amount of drainage in TPT statistically significant.
Statistical significance was not determined in other comparative values.
Hospital mortality was 2 (3.5%). A patient with Down syndrome who
underwent CAVSD repair with a MSP and both left and right AV valve
repair died due to aspiration pneumonia in the early period after
discharge. The second patient had multiple muscular VSDs and was
previously palliated with pulmonary banding due to high pulmonary
pressure. The patient, who needed a permanent postoperative pacemaker
following repair with the TPT, died due to respiratory failure in
intensive care follow-ups.
In terms of the long term (mean:73 months) results of these patients;
early mortality within 22 months was 4.4% with 2 patients and late
mortality was 6.6% with 3 patients. Overall mortality rate was 11.1%.
Three among the five patients who died, had been operated using TPT and
the other two with MSP. Two patients died due to non-cardiac causes
whereas we lost our 3 patients from cardiac causes. One patient who died
due to cardiac reasons had permanent pacemaker and sudden death was
reported due to rhythm disturbance. One of the other two patients was
lost in our center and the other one in an external center after
reoperation which was made due to LAVV insufficiency. Overall survival
was determined as 89,9 for 73 monhts. While early reoperation was not
performed after discharge, 3 patients (6.6%) were reoperated in the
late period due to LAVV insufficiency. Two of these patients were
operated in our center within five years, one was operated at a later
period in the other center. Five-year survival without reoperation was
95.6% and ten-years survival was 93.4%. MSP was applied to one patient
who underwent reoperation and the other two patients with TPT. There was
no statistical difference in long term term result of the both
tecniques.