Minimally invasive perventricular vsd closure without cardiopulmonary bypass mid-term results from multi-centers

Abstract

：ObjectiveTransesophageal echocardiography (TEE) guided, minimally invasive perventricular deviceocclusion of ventricular septal defects ( VSDs) without cardiopulmonary bypass ( CPB) hasbeen applied in multiple centers. We reported experiences and the mid-term results.Methods Four hundred and thirty-two cases from 4 cardiac centers were involved in thestudy. There were 235 males and 197 females, aged from 3 months to 15 years, with a bodyweight varying from 4.0 to 26.0 kg. Three hundred and fifty-one patients hadperimembranous VSDs, 57 had intracristal or supracristal VSDs and 24 had muscular VSDs (17had multiple muscular VSDs). The diameter of the VSD ranged from 3 to 12 (5.3 ±1.6 )mm.For those with perimembranous or muscular VSDs, a 3 to 5 cm inferior sternotomy wasmade, but for those with intracristal or supracristal VSDs, a 2 to 3 cm incision was madeparastemally through the left third intercostal space. Being monitored and guided withTEE, the device was deployed to occlude the VSD through the puncture at the free wall ofthe right ventricle. TEE was used for assessing the residual shunting, the left and rightventricular outlet tracts, valvular function and for detecting any arrhythmia, The deviceswould be released if the heart rhythm was normal, as well as the residual shunting andvalvular regurgilalion were not detected. Results The procedure was completed successfullyin 417 cases(96.5% ) and converted to traditional surgical closure with CPB in the other15 cases(3.5% ). Concentric devices were used in 238 cases(57.1% )and eccentric deviceswere used in 179 patients(42.9% ). Successful procedures finished in less than 90 minutes,and the deployment and evaluation of the devices were completed in 5 to 60 (18. 2 ± 8.6)minutes. No residual shunt and detectable aortic or tricuspid insufficiency and arrhythmiawas observed. Patients were extubated within 2 hours and discharged 3 to 5 days after theoperation. During fellow-up period from 3 months to 2 years, no clinically significantcomplications occurred. Conclusion The minimally invasive device closure of VSD under TEEguidance without CPB is proved to be a simple, safe and effective treatment for aconsiderable number of children with VSD. Its use in the clinical practice should beencouraged.