Comparison of Clinical Outcome of Transcatheter Closure of Ventricular Septal Defect Using Antegrade and Retrograde Approaches

Abstract

INTRODUCTION: Transcatheter device closure became a trending treatment for ventricular septal defect for perimembranous and muscular type with satisfactory results and low morbidity rates. In most centers, the procedure is performed using antegrade method or transvenous approach. In adult patients, recent studies of transcatheter VSD closure via retrograde or transarterial approach have been successful. However, in pediatric patients, this kind of approach have insufficient data available. This study aims to compare the clinical outcome of transcatheter device closure of ventricular septal defect using antegrade and retrograde approaches among patients of our institution from January 2013 to July 2018. METHODS: To compare the outcomes of two approaches, we retrospectively evaluated early and mid-term results of device closure for VSD in 72 patients divided into 2 groups (A and B) composed, respectively, of 37 patients (antegrade) and 35 patients (retrograde). RESULTS: Procedure time between groups with group A 39.2+13.8 min and with group B 27.3+10.8 min (p<0.0001) were found to be significant. There is a significant difference in clinical outcome between the groups with number of complications in group A is 10 (27%) and in group B is 2 (5.7%). Antegrade patients were more likely to have complications compare to retrograde patients with a p-value of 0.027. Embolization of the device was the early adverse events observed on both groups. Data from midterm follow-up showed that, in antegrade group, new onset valvular insufficiency and residual shunts were more frequent. CONCLUSION: Both therapeutic approaches for transcatheter device closure of VSD were immediately safe and effective but retrograde approach is less likely to have complication compared to antegrade procedure. Patients must be accurately selected before choosing VSD device closure approach; operator skills and experience still have a large impact on success rate for this procedure. KEYWORDS: Ventricular septal defect, VSD device closure, retrograde approach, antegrade approach