Minimally invasive transthoracic device closure of isolated ventricular septal defects without cardiopulmonary bypass: Long-term follow-up results

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 149; no. 1; pp. 257 - 265
• Main Authors: Xing, Quansheng, MD, Wu, Qin, MD, Shi, Lei, MB, Xing, Yuhan, MB, Yu, Guiling, MS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2015
• Subjects: Adolescent; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Cardiac Surgical Procedures - adverse effects; Cardiopulmonary Bypass; Cardiothoracic Surgery; Child; Child, Preschool; Echocardiography, Transesophageal; Female; Heart Septal Defects, Ventricular - diagnosis; Heart Septal Defects, Ventricular - surgery; Heart Septal Defects, Ventricular - therapy; Humans; Male; Prosthesis Design; Retrospective Studies; Septal Occluder Device; Time Factors; Treatment Outcome; Young Adult; TTE; VSD; cAVB; IVS; ECG; MITDC; transthoracic echocardiography; PDA; interventricular septum; electrocardiography; tricuspid regurgitation; CPB; TEE; cardiopulmonary bypass; minimally invasive transthoracic device closure; patent ductus arteriosus; transesophageal echocardiography; ventricular septal defect; 28.2; 20; complete atrioventricular block; TR
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2014.07.078

Objective Minimally invasive transthoracic device closure (MITDC) of ventricular septal defects (VSD) under transesophageal echocardiography guidance is increasingly and successfully being performed with excellent results. We retrospectively reviewed 458 patients who received this treatment in our center and summarized the 6-year follow-up results. Methods From March 2007 to March 2013, 458 patients (mean age, 11.41 ± 6.73 months; body weight, 9.82 ± 5.88 kg) underwent MITDC. Patients were strictly followed up according to a standard protocol by 2 specially appointed doctors. Meanwhile, 283 cases with an isolated VSD who underwent traditional surgical repair during this period were also reviewed and several characteristics were compared between the 2 groups. Results A total of 441 cases were successfully closed (96.29%), and the other 17 patients were converted to surgical closure. There were no deaths or major complications. Concentric devices were used in 313 cases (70.98%), eccentric devices in 113 cases (25.62%), and special devices in 15 cases (3.40%). The mean intracardiac deployment time was 18.35 ± 17.13 minutes (3-48 minutes). Most of the patients were discharged within 5 days after surgery. Follow-up in 426 patients (96.60%) ranged from 6 to 78 months (47.31 ± 19.69 months) and revealed no severe complications. Fewer minor complications, such as device-related trace to mild tricuspid regurgitation, residual shunt, and right bundle branch block, occurred with MITDC than surgical closure. Conclusions MITDC of a VSD on a beating heart is a safe and effective alternative to conventional treatments. The 6-year clinical outcomes are promising. Modification of occluders and the delivery set play an important role in good outcomes.