Perventricular device closure of doubly committed sub‐arterial ventricular septal defects via a left infra‐axillary approach

• Published in: Journal of cardiac surgery Vol. 32; no. 6; pp. 382 - 386
• Main Authors: Zhou, Sijie, Zhao, Liyun, Fan, Taibing, Li, Bin, Liang, Weijie, Dong, Haoju, Song, Shubo, Liu, Lin
• Format: Journal Article
• Language: English
• Published: United States 01.06.2017
• Subjects: Cardiac Surgical Procedures - instrumentation; Cardiac Surgical Procedures - methods; Child, Preschool; cosmetic effect; device closure of dcVSD; doubly committed subarterial ventricular septal defect; Echocardiography, Transesophageal; Female; Follow-Up Studies; Heart Septal Defects, Ventricular - diagnostic imaging; Heart Septal Defects, Ventricular - surgery; Humans; Infant; left infra‐axillary route; Male; perventricular device closure; Septal Occluder Device; Surgery, Computer-Assisted - instrumentation; Surgery, Computer-Assisted - methods; Treatment Outcome; left infra-axillary route; cosmetic effect; perventricular device closure; device closure of dcVSD; doubly committed subarterial ventricular septal defect
• ISSN: 0886-0440; 1540-8191
• DOI: 10.1111/jocs.13155

Background This study sought to evaluate the feasibility, safety, and efficacy of perventricular device closure of a doubly committed sub‐arterial ventricular septal defect (dcVSD) through a left infra‐axillary approach. Method Forty‐five patients, with a dcVSD of less than 8 mm in diameter, were enrolled in this study. The pericardium was exposed and opened through a left infra‐axillary mini‐incision. Two parallel purse‐string sutures were placed on the right ventricle outflow tract and under transesophageal echocardiography guidance, a delivery sheath loaded with the device was inserted into the right ventricle and advanced through the defect into the left ventricle. The device, connected to a delivery cable, was then deployed. Results Forty‐one patients achieved successful device closure. In four patients, the device failed to occlude the VSD due to device dislodgement, device‐related aortic regurgitation, and residual shunts, and open surgical repair was required. The mean dcVSD diameter was 4.5 ± 1.0 mm (range, 3.0‐8.0 mm). The implanted device size was 6.0 ± 1.5 mm (range, 4‐10 mm). All patients were implanted with an eccentric device. The mean intracardiac manipulation time was 20.9 ± 7.1 min (range, 9‐45 min). The procedure time was 62.5 ± 19.5 min (range 34‐105 min). There were no severe adverse events. Conclusions Perventricular device closure of a dcVSD through a left infra‐axillary approach is feasible, safe, and efficacious in selected patients with dcVSD.