Background: Transatrial approach is the standard method in repairing ventricular septal defect in pediatric population. However, tricuspid valve (TV) apparatus might obscure the inferior border of the VSD risking the adequacy of repair by leaving residual VSD or heart block. Detachment of the TV chordae has been described as an alternative technique to TV leaflet detachment. Aim of this study is to investigate the safeness of such technique.
Methods: Retrospective review of patients who underwent VSD repair between 2015 and 2018. Group A (n=25) had VSD repair with TV chordae detachment were matched for age and weight to group B (n=25) without tricuspid chordal or leaflet detachment. ECG and echocardiogram at discharge and at 3 years of follow-up were reviewed to identify new ECG changes, residual VSD and TV regurgitation.
Results: Median age in group A and B were 6.13 (IQR 4.33-7.91) and 6.33 (4.77- 7.2) months. New onset right bundle branch block (RBBB) was diagnosed at discharge in 28% (n=7) of group A versus 56% (n=14) in group B (p= 0.044), while the incidence dropped to 16% (n=4) in group A versus 40% (n=10) in group B (p= 0.059) in the 3 years follow-up ECG. Echocardiogram at discharge showed moderate tricuspid regurgitation in 16% (n=4) in group A and 12% (n=3) in group B (p=0.867). 3 years follow-up echocardiography revealed no moderate or severe tricuspid regurgitation and no significant residual VSD in either group.
Conclusion: No significant difference in operative time was observed between the 23 two techniques. TV chordal detachment technique reduces the incidence of 24 postoperative RBBB without increasing the incidence of TV regurgitation at discharge
