Surgical Repair of Ventricular Septal Defect in Neonates: Indications and Outcomes

Background: The optimal surgical timing and clinical outcomes of ventricular septal defect (VSD) closure in neonates remain unclear. We aimed to evaluate the clinical outcomes of VSD closure in neonates (age <= 30 days). Methods: We retrospectively reviewed 50 consecutive neonates who underwent VSD closure for isolated VSDs between August 2003 and June 2021. Indications for the procedure included congestive heart failure/failure to thrive and pulmonary hypertension. Major adverse events (MAEs) were defined as the composite of all-cause mortality, reoperation, persistent atrioventricular block, and significant (>= grade 2) valvular dysfunction. Results: The median age and body weight at operation were 26.0 days (interquartile range [IQR], 18.8-28.3) and 3.7 kg (IQR, 3.3-4.2), respectively. The median follow-up duration was 110.4 months (IQR, 56.8-165.0). Seven patients required preoperative respiratory support, and five had significant (>= grade 2) preoperative valvular dysfunction. One early mortality occurred due to irreversible cardiogenic shock; no late mortality was observed. One reoperation was due to hemodynamically significant residual VSD at 103.8 months postoperatively. The overall survival, freedom from reoperation, and freedom from MAE at 15-years were 98.0%, 96.3%, and 94.4%, respectively. Preoperative mechanical ventilation was associated with a longer duration of postoperative mechanical ventilation (p < 0.001) and a longer length of intensive care unit stay (p < 0.001). Conclusions: VSD closure with favorable outcomes without morbidities is feasible even in neonates. However, neonates requiring preoperative respiratory support may require careful postoperative management considering the long-term postoperative risks. Overall, surgical VSD closure might be indicated earlier in neonates with respiratory compromise.