307 Contemporary treatment of isolated vsd in children: amplatzer vs surgical closure

Abstract

Isolated hemodynamically significant Ventricular septal defects (VSD) were once solely surgical lesions. Since the introduction of percutaneous devices, the management of isolated VSD has evolved. In our center, Amplatzer devices have been implanted since 1998 and for selected isolated perimembranous and muscular VSD since 2002. We therefore reviewed our institutional practice selectively using percutaneous and surgical approaches. We retrospectively reviewed clinical, electrocardiographic and echocardiographic data of all isolated percutaneous and surgical VSD closures since 2002. Pre-operative (preop), immediate post-operative (postop) in addition to 1 month, 6 month and annual postop results were studied. The following table summarizes demographic data: 37 patients who underwent percutaneous closures and 34 who treated surgically, mean follow-up 42 months. Percutanous group were older ( p < 0.01 ) and bigger ( p<0.001 ). The VSD gradient preop was lower in the surgical group ( p < 0.004 ), thus patients were in greater clinical heart failure. There was no mortality in either group. At follow-up there were no differences in the incidence of residual VSD ( p = 0.34 ). 2 patients with perimembranous VSD and pre-existing aortic valve deformity increased its level to moderate post-Amplatzer implantation versus none in the surgical group ( p = 0.45 ). A permanent pacemaker was implanted for complete heart block following post device closure of a perimembranous VSD in one patient and none in the surgical group. The surgical results are excellent in this sicker patient population, as reported in the literature. Patient selection remains a challenge to avoid post-percutaneous intervention complications such as heart block and aortic insufficiency in the perimembranous VSD patients. Percutaneous closure of isolated VSD, which avoids some morbidity of open heart surgery should however remain part of the therapeutic armamentarium. Results table Amplatzer group median (min-max) Surgical group median (min-max) P value Age (year) 12,83 (0,67-21,33) 1,41 (0,16-5,66) p<0,001 Weight (Kg) 24,6 (5,35-77,9) 5,00 (4,1-18,5) p<0,001 VSD size (mm) 5,7 (2,1-19) 11,00 (9,00-12,00) p<0,02 VSD Gradient (mmHg) 87 (54-138) 33 (25-66) p<0,004 LVEF (%) 59 (52,21-68,87) 60 (56,42-72,52) NS CPB duration (min.) N.A. 78,5 (70-150) - Aortic cross-clamp (min.) N.A. 55,5 (36-125) - Device size (mm) 8 (6-14) N.A. -