Short- and long-term outcomes
The overall reported perioperative mortality for patients undergoing
conventional repair of multiple septal defects, including the
Swiss-cheese variety, has been cited to be between zero and
14.2%.1-15,29-62 The causes of death were due to
intractable pulmonary hypertensive crises, residual defects, and
congestive cardiac failure. The requirement of reoperation for residual
defects has been between 6 and13%, with a reoperative mortality of
around 33%.1-15,29-62 The STS Congenital Heart
Surgery Spring 2017 Database provides results from 116 participating
centers on 7322 operations for ventricular septal defects over 4 years
with a mean operative mortality of 0.6%, mean cardiopulmonary bypass
time of 77 minutes and cross-clamp time of 49
minutes.29-32 Repair for multiple defects, their
“category 2”, accounted for 4.5% of operations, with an operative
mortality of 2.6%, requirement of mechanical circulatory support in
2.6%, and the need for a permanent pacemaker in 3.4% of cases. When
compared with isolated perimembranous defects, the rate of mortality was
thrice as high with multiple defects, the rate of reoperation was over 4
times higher with muscular defects, and the rate of heart block was 3
times higher with muscular and multiple septal
defects.1,29-32 It is not possible, however, to
interrogate the registry according to outcomes for the different
anatomical subsets.
Opinion is divided on the recommendation of limited apical left
ventriculotomy for closure of apical defects. Although favorable short-
and long-term results have been reported by some investigators, others
have reported left ventricular dysfunction apical aneurysm formation,
and ventricular arrhythmia in long-term survivors undergoing left
ventriculotomy.2,41,43,46,47,57-60,61,65
Recent results of use of devices inserted percutaneously to close
multiple septal defects have allegedly been
encouraging.19-28,54,55,66,75,76 In terms of outcomes,
nonetheless, in some of these small series rates of mortality have been
between 14 and 24%, with rates of failure between 20 and
40%.53,75,76 In a combined series, Holzer and
associates reported the results of a multicentric trial involving 14
tertiary referral centers in the United States of America. They
collected outcomes from 75 treated patients, finding a total of 59
(45%) adverse events, and 10.7% major procedure-related complications,
including device embolization, cardiac perforation, stroke. There were
two deaths (2.7%).20-28,60,66-70,75