Minimally Invasive Perventricular Device Closure of Ventricular Septal Defect: a Comparative Study in 80 Patients

doi:10.1016/S1001-9294(14)60035-3

摘要/Abstract

摘要： Objective To evaluate the efficacy of minimally invasive perventricular device closure of ventricular septal defect (VSD).Methods Between September 2011 and February 2013, we collected 40 patients who underwent perventricular closure via a small lower sternal incision (minimally invasive group), aged 15.5±3.5 years (12 months to 32 years) with a body weight of 24.2±7.5 kg (10.8-58.0 kg). The mean size of VSD was 5.6±0.5 mm (2-14 mm). Another 40 patients were included as the surgical group, receiving the conventional surgical repair of VSD. The device of the minimally invasive group was released under the guidance of transesophageal echocardiography. Success rate, cardiac indicators, and clinical outcomes of the 2 groups were compared.Results The patients in the surgical group and those in the minimally invasive group showed similar results in success rate (both 97.5%). The procedure time, intensive care unit stay, hospital stay, and postoperative recovery time in the minimally invasive group were significantly shorter than those in the surgical group (58±21 minutes versus 145±26 minutes, 2±1 days versus 8±3 days, 5±1 days versus 16±6 days, 3±1 days versus 90±20 days, all P<0.05). The minimally invasive group had a higher incidence of conduction anomalies (17.5% versus 2.5%, P<0.05). In the follow-up period of 3-12 months, there was no new residual shunt, noticeable aortic regurgitation, significant arrhythmias, or device failure except for new complications in the surgical group.Conclusions The success rate of minimally invasive perventricular device closure of VSD under transesophageal echocardiography guidance is similar to that of conventional surgical repair, but the short-term outcomes of the minimally invasive approach is much better. Long-term follow-up is necessary to confirm the effectiveness of this technique.

关键词: transesophageal echocardiography, minimally invasive, ventricular septal defect

Abstract: Objective To evaluate the efficacy of minimally invasive perventricular device closure of ventricular septal defect (VSD).Methods Between September 2011 and February 2013, we collected 40 patients who underwent perventricular closure via a small lower sternal incision (minimally invasive group), aged 15.5±3.5 years (12 months to 32 years) with a body weight of 24.2±7.5 kg (10.8-58.0 kg). The mean size of VSD was 5.6±0.5 mm (2-14 mm). Another 40 patients were included as the surgical group, receiving the conventional surgical repair of VSD. The device of the minimally invasive group was released under the guidance of transesophageal echocardiography. Success rate, cardiac indicators, and clinical outcomes of the 2 groups were compared.Results The patients in the surgical group and those in the minimally invasive group showed similar results in success rate (both 97.5%). The procedure time, intensive care unit stay, hospital stay, and postoperative recovery time in the minimally invasive group were significantly shorter than those in the surgical group (58±21 minutes versus 145±26 minutes, 2±1 days versus 8±3 days, 5±1 days versus 16±6 days, 3±1 days versus 90±20 days, all P<0.05). The minimally invasive group had a higher incidence of conduction anomalies (17.5% versus 2.5%, P<0.05). In the follow-up period of 3-12 months, there was no new residual shunt, noticeable aortic regurgitation, significant arrhythmias, or device failure except for new complications in the surgical group.Conclusions The success rate of minimally invasive perventricular device closure of VSD under transesophageal echocardiography guidance is similar to that of conventional surgical repair, but the short-term outcomes of the minimally invasive approach is much better. Long-term follow-up is necessary to confirm the effectiveness of this technique.

Key words: transesophageal echocardiography, minimally invasive, ventricular septal defect

Xin-chao Yang, De-bin Liu*. Minimally Invasive Perventricular Device Closure of Ventricular Septal Defect: a Comparative Study in 80 Patients[J].Chinese Medical Sciences Journal, 2014, 29(2): 98-102.

参考文献 1.

1.	Yang R, Sheng Y, Cao K, et al. Transcatheter closure of perimembranous ventricular septal defect in children: safety and efficiency with symmetric and asymmetric occluders. Catheter Cardiovasc Interv 2011; 77:84-90.
	2.Zhao PJ, Yu ZQ, Gao W, et al. Efficacy of the transcatheter closure of perimembranous and muscular ventricular septal defects with the Amplatzer duct occluder II. Zhonghua Xin Xue Guan Bing Za Zhi 2012; 40:817-20.
	3.Koneti NR, Penumatsa RR, Kanchi V, et al. Retrograde transcatheter closure of ventricular septal defects in children using the Amplatzer Duct Occluder II. Catheter Cardiovasc Interv 2011; 77:252-9.
	4.Koneti NR, Sreeram N, Penumatsa RR, et al. Transcatheter retrograde closure of perimembranous ventricular septal defects in children with the Amplatzer duct occluder II device. J Am Coll Cardiol 2012; 60:2421-2.
	5.Li F, Chen M, Qiu Z, et al. A new minimally invasive technique to occlude ventricular septal defect using an occluder device. Ann Thorac Surg 2008; 85:1067-71.
	6.Zhu D, Gan C, Li X, et al. Perventricular device closure of perimembranous ventricular septal defect in pediatric patients: technical and morphological considerations. Thorac Cardiovasc Surg 2013; 61:300-6.
	7.Zhang GC, Chen Q, Chen LW, et al. Transthoracic echo- cardiographic guidance of minimally invasive perventricular device closure of perimembranous ventricular septal defect without cardiopulmonary bypass: initial experience. Eur Heart J Cardiovasc Imaging 2012; 13:739-44.
	8.Amin Z, Danford DA, Lof J, et al. Intraoperative device closure of perimembranous ventricular septal defects without cardiopulmonary bypass: preliminary results with the perventricular technique. J Thorac Cardiovasc Surg 2004;127:234-41.
	9.Amin Z, Berry JM, Foker JE, et al. Intraoperative closure of muscular ventricular septal defect in a canine model and application of the technique in a baby. J Thorac Cardiovasc Surg 1998;115:1374-6.
	10.Amin Z, Gu X, Berry JM, et al. New device for closure of muscular ventricular septal defects in a canine model. Circulation 1999;100:320-8.
	11.Bacha EA, Cao QL, Starr JP, et al. Perventricular device closure of muscular ventricular septal defects on the beating heart: technique and results. J Thorac Cardiovasc Surg 2003;126:1718-23.
	12.Maheshwari S, Suresh P, Bansal M, et al. Perventricular device closure of muscular ventricular septal defects on the beating heart. Indian Heart J 2004;56:333-5.
	13.Zeng XJ, Sun SQ, Chen XF, et al. Device closure of perimembranous ventricular septal defects with a minimally invasive technique in 12 patients. Ann Thorac Surg 2008;85:192-4.
	14.Xing Q, Pan S, An Q, et al. Minimally invasive perventricular device closure of perimembranous ventricular septal defect without cardiopulmonary bypass: multicenter experience and mid-term follow-up. J Thorac Cardiovasc Surg 2010;139:1409-15.
	15.Gan C, Lin K, An Q, et al. Perventricular device closure of muscular ventricular septal defects on beating hearts: initial experience in eight children. J Thorac Cardiovasc Surg 2009;137:929-33.
	16.Pan S, Xing Q, Cao Q, et al. Perventricular device closure of doubly committed subarterial ventral septal defect through left anterior minithoracotomy on beating hearts. Ann Thorac Surg 2012;94:2070-5.
	17.Majunke N, Bialkowski J, Wilson N, et al. Closure of atrial septal defect with the Amplatzer septal occluder in adults. Am J Cardiol 2009;103:550-4.
	18.Vaidyanathan B, Simpson JM, Kumar RK. Transesophageal echocardiography for device closure of atrial septal defects: case selection, planning, and procedural guidance. JACC Cardiovasc Imaging 2009;2:1238-42.
	19.Seca L, Cação R, Silva J, et al. Intracardiac echocardiography imaging for device closure of atrial septal defects——a single-center experience. Rev Port de Cardiol (English Edition) 2012;31:407-12.
	20.Hongxin L, Wenbin G, Zhu M, et al. New minimally invasive technique of perpulmonary device closure of patent ductus arteriosus through a parasternal approach. Ann Thorac Surg 2012;93:862-8.
	21.Tao K, Zhu D, An Q, et al. Perventricular device closure of patent ductus arteriosus: a secondary chance. Ann Thorac Surg 2012;93:1007-9.
	22.Predescu D, Chaturvedi RR, Friedberg MK, et al. Complete heart block associated with device closure of perimembranous ventricular septal defects. J Thorac Cardiovasc Surg 2008;136:1223-8.

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