ASSOCIATED ATRIAL SEPTAL-DEFECTS INCREASE PERIOPERATIVE MORBIDITY AFTER VENTRICULAR SEPTAL-DEFECT REPAIR IN INFANCY

Although closure of ventricular septal defects (VSDs) is currently ass ociated with a relatively low risk, infants with associated atrial sep tal defects (ASDs) seem to have a higher perioperative morbidity. To c larify this impression, we reviewed our entire experience (since 1977) with closure of simple VSDs in 163 infants (age,less than or equal to 12 months). Of these, 57 had significant ASDs (ASD-VSD subgroup). Hos pital mortality was 3.7% (6/163) overall and 1.4% (2/145) since 1980. Actuarial survival at 10 years was 92% +/- 5%. Significant morbidity o ccurred in 15.5% (16/103) of the VSD subgroup versus 48.1% (26/54) of the ASD-VSD subgroup (p less than or equal to 0.001). Multivariate ana lysis identified the presence of multiple VSDs and early date of opera tion as risk factors for hospital death, and younger age, an associate d ASD, the size of the VSD, and use of hypothermic circulatory arrest as risk factors for significant perioperative morbidity. Compared with the VSD subgroup, the ASD-VSD subgroup had a higher hospital mortalit y (5.3% [3/57] versus 2.8% [3/106]), were younger (5.1 +/- 2.9 versus 7.2 +/- 2.9 months; p = 0.001), had a higher preoperative pulmonary ar tery pressure (70.2 +/- 19.0 versus 62.7 +/- 21.8 mm Hg; p = 0.08), ne eded more inotropic support (12.3% versus 3.7%; p = 0.07), needed more prolonged ventilation (3.3 versus 1.8 days; p = 0.02), and had longer postoperative hospital stays (11 versus 8 days; p = 0.005). The incre ased postoperative morbidity associated with infants who have a signif icant ASD in addition to a VSD is generally unappreciated, and may rel ate to the different hemodynamics associated with left-to-right shunti ng at both the atrial and ventricular levels.