Pulmonary Artery Venting in Ventricular Septal Defects with Pulmonary Hypertension Compared to Ordinary Routes of Left Ventricular Venting

Elsharkawy, Ihab M.; Elwakeel, Ahmed M.; Elwakeel, Mahmoud M.; Lamloom, Ahmed H.

doi:10.21608/ejhm.2022.256619

Pulmonary Artery Venting in Ventricular Septal Defects with Pulmonary Hypertension Compared to Ordinary Routes of Left Ventricular Venting

Authors

10.21608/ejhm.2022.256619

Abstract

Background: Ventricular septal defect (VSD) closure in patients with reversible pulmonary hypertension is a risky procedure regarding intra- and post-operative course. The classic left ventricle (LV) venting has its own reported complications and cannot unload the distending right ventricle (RV) at the end of the repair. We are assuming usage of pulmonary artery (PA) venting in ventricular septal defect-pulmonary hypertension (VSD-PH) cases will be less problematic and more effective compared to venting through other ways.
Patients and methods: Data of 100 patients with VSD-PH listed for isolated VSD closure in Cairo University Hospitals were collected and cases were divided into 2 groups; Group 1 had pulmonary artery venting, and Group 2 had no pulmonary artery venting. Both groups were compared for preoperative, operative and postoperative variables.
Results: Both groups had similar preoperative characteristics, with Group 1 including 51 patients compared to 49 patients in Group 2.Data reported 15 minutes shorter cross clamping time (AXC) (p-value 0.001), transesophageal echocardiogram (TEE) has never observed air in the left heart or aorta and 0.6 days shorter ICU stay (p-value 0.002) in Group 1, mean hospital stay was 6.4 (SD 1.7) in Group 1 and 8.7 (SD 2.2) in Group 2 (p-value 0.001). There was no significant difference in the incidence of ventricular fibrillation after each type of vent had been used (p-value >0.05), and there was 30% less need for inotropic support in Group 1 (29 % vs 59%, p-value 0.02).
Conclusion: venting through PA on operating cases with VSD-PH is effective regarding creating bloodless field facilitating the surgical procedure, decompressing right ventricle after aortic de-clamping, and is associated with shorter ICU and hospital stay.

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