Hybrid Transthoracic Periventricular Device Closure of Ventricular Septal Defects: Single- Center Experience.

Liying Wu,Liying Wu,Liying Wu,Dongting Ye,Dongting Ye,Dongting Ye,Ibrahim Cansaran Tanidir,Gaopi Deng,Bin Li,Bin Li,Bin Li,Haisheng Chen,Haisheng Chen,Haisheng Chen,Daliang Zhu,Daliang Zhu,Daliang Zhu,Xiong Zhang,Xiong Zhang,Xiong Zhang

doi:10.21470/1678-9741-2020-0115

Abstract

ObjectiveTo evaluate the efficacy of hybrid transthoracic periventricular device closure of ventricular septal defects (VSDs) in a single center.MethodsAll patients who underwent hybrid transthoracic periventricular device closure of VSDs between January 2018 and December 2019 were retrospectively analyzed. The preoperative, operative and postoperative findings and clinical follow-ups were reviewed.ResultsA total of 59 patients underwent the procedure. Transesophageal echocardiographic guidance was used in all procedures. The procedure was successful in 57 procedures (97%). The procedures of two patients were changed to open-heart surgery during the same intervention due to severe aortic insufficiency (the device was not deployed) and significant residual shunt after device deployment. One major complication (1.7%) was observed after the procedure. The patient’s device was dislodged within 12 hours after the procedure, and this patient underwent device extraction and VSD patch closure due to significant residual shunt. Eight (14%) minor complications were observed after the procedure, and three of them persisted during follow-up. Three of these eight complications were incomplete right bundle branch block, one of which resolved during follow-up; two were mild residual shunts, one of which resolved during follow-up; two were mild new-onset tricuspid valve insufficiencies; and one was mild new-onset mitral valve insufficiency; all valvular insufficiencies were resolved during follow-up.ConclusionsHybrid transthoracic periventricular device closure of VSD seems to be a good alternative approach due to its procedural success and low risk rates. The best advantage of the procedure is the possibility of switching to open-heart surgery, if necessary.

Highlights

Invasive surgery for congenital heart disease in pediatric/adult patients traditionally refers to therapeutic approaches designed to minimize the physical trauma associated with surgery and thereby maximize the likelihood of rapid recovery with minimal morbidity
Based on the two methods mentioned, the hybrid periventricular device closure of ventricular septal defects (VSDs) was designed to combine the advantages of both approaches, allowing direct access to the defect without cardiopulmonary bypass (CPB) but with guidance by transesophageal echocardiography (TEE) or transthoracic echocardiography (TTE)
One patient had severe aortic valve insufficiency (AI), detected when the occluder was placed into the defect

Summary

Introduction

Invasive surgery for congenital heart disease in pediatric/adult patients traditionally refers to therapeutic approaches designed to minimize the physical trauma associated with surgery and thereby maximize the likelihood of rapid recovery with minimal morbidity. Based on the two methods mentioned (surgical and transcatheter), the hybrid periventricular device closure of VSDs was designed to combine the advantages of both approaches, allowing direct access to the defect without CPB but with guidance by transesophageal echocardiography (TEE) or transthoracic echocardiography (TTE). These procedures, which involve smaller incisions, are designed to produce better cosmetic results and reduce rehabilitation time and pain compared to traditional open-heart surgery. This method has been widely used in China with promising results[1,2,3,4,5,6,7,8,9]

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Results

Conclusion