Is early correction of congenital ventricular septal defect a better option in a developing country?

Objective: To assess and evaluate the effectiveness of early ventricular septal defect (VSD) repair in a developing country by comparing the outcomes in two age groups.

Methods: A total of 39 patients underwent VSD repair at a tertiary care hospital in Karachi over a period of 2.5 years. Patients were divided into Group 1 (<2 years) and Group 2 (2-18 yrs). Perioperative and postoperative variables were reviewed retrospectively for each patient and compared with the development of complications and the effect on postoperative recovery times. The data was analyzed using Mann Whitney test for continuous variables and Fischer's exact test for categorical variables.

Results: Mean age at surgery was 10.1 +/- 7.0 months and 108.5 +/- 54.0 months for both groups, respectively. Two patients died. Procedure time was not affected by decreasing age (p = 0.622) but Cardio pulmonary Bypass duration (p = 0.040) and Aortic Cross Clamp time (p = 0.063) were significantly affected. No associated significance was obtained when hospital stay (p = 0.085) was observed. Increased duration of ventilation (p = 0.000) and length of ICU stay (p = 0.003) were highly significant for the younger age group. Presence of residual VSD (p = 0.025) was also significantly affected by lower age. There was no significant difference in the number of patients with complications (p = 1.000) among the 2 groups.

Conclusion: Age does not increase morbidity rates after VSD repair although postoperative recovery times are increased with decreasing age. Hence, there is no justification in delaying VSD repair.