Outcome of ventricular septal defect repair in a developing country

Objectives: To examine the impact of nutrition and lung infection on outcome early after ventricular septal defect (VSD) repair in infants in a developing country. Study design: One hundred consecutive infants (age, 7.4 +/- 3.3 months) with large VSD(s) who underwent surgical repair at one institution in South India from July 1998 to June 2000 were analyzed. Primary outcome variables were postoperative death, duration of mechanical ventilation, intensive care unit (ICU) stay, and hospital stay. Preoperative variables analyzed included age, weight and length Z scores, and lung infection. Results: Preoperative nutrition was poor (weight Z score, -2.8 +/- 1.3), and 25 patients had pneumonia. Six patients died after repair. No preoperative variable was associated with death. Mechanical ventilation, ICU stay, and hospital stay were longer for younger patients (r(s) for ventilation, -0.23, P = .02; for ICU stay, -0.33, P < .001; for hospital stay, -0.27, P = .007) and for those with preoperative pneumonia (median ventilation duration, 46 vs 24 hours, P < .001; median ICU stay 7 vs 4 days, P < .001; median hospital stay 10 vs 7 days, P = .001). Preoperative weight and length Z scores were not associated with any outcome variable. Conclusions: Poor nutritional status, preoperative pneumonia, and age do not increase mortality rates after VSD repair. Repair of large VSDs should not be delayed because of these preoperative characteristics.