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Yang Y, Xi L, Li H. A Retrospective Study in Occluding Sub-arterial Ventricular Septal Defect. Pediatr Cardiol 2024; 45:410-415. [PMID: 37803227 DOI: 10.1007/s00246-023-03309-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023]
Abstract
To assess the safety and effectiveness of utilizing eccentric occlusion for the treatment of sub-arterial ventricular septal defects, we performed a retrospective study on the classification and analysis of relevant cases. A total of 105 patients with a minimally invasive incision were enrolled in this study, from April 2018 to September 2022. All patients underwent treatment of transthoracic sub-arterial ventricular septal defect occlusion. We analyzed the causes of closure failure, indication, and complication. Briefly, the closure device was successfully implanted in 78 cases (74.2%) with a mean age of 31.4 ± 31.8 months, VSD size of 4.3 ± 0.9 mm, and device size of 6.0 ± 1.1 mm. However, 27 cases (25.8%) required cardiopulmonary bypass due to failure of occlusion. The reasons for failure included 13 cases with worsened aortic regurgitation, two cases with worsened aortic valve prolapse, one case with worsened mitral regurgitation, eight cases with significant residual shunt, and three cases with deviated occlusion morphology. During the 1-36-month follow-up visit, no cases experienced displacement of the eccentric umbrella, shedding, or arrhythmia. All residual shunts resolved during the visit. We concluded that occlusion for sub-arterial VSD has sufficient security and feasibility, under the strict control of surgical indications, appropriate choice of occluder and precise perioperative management.
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Affiliation(s)
- Yan Yang
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
| | - Linyun Xi
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China
| | - Hongbo Li
- Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China.
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, No.136, Zhongshan 2nd Road, Yuzhong Dis, Chongqing, 400014, China.
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Jiang Y, Luo F, Bu H. Percutaneous closure of simple congenital heart diseases under echocardiographic guidance. Eur J Med Res 2023; 28:408. [PMID: 37805534 PMCID: PMC10559656 DOI: 10.1186/s40001-023-01398-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023] Open
Abstract
Congenital heart disease (CHD), birth defect with the highest incidence rates worldwide, and is mainly characterized by the abnormal internal structure of the heart or/and the anatomical structure of great vessels. In the past few decades, CHD repair surgery through standard median sternotomy incision combined with cardiopulmonary bypass (CPB) technology has been considered the gold standard for surgical correction of heart and great vessels. With the promotion and clinical application of interventional catheterization technology, transcatheter closure of CHD under radioactive radiation has gradually been recognized and applied. However, its radiation exposure and potential complications related to arteriovenous vessels still face challenges. In recent years, an increasing number of surgeons have explored new surgical procedures, for the safe and effective treatment of CHD, as far as possible to reduce surgical trauma, avoid radiation exposure, and improve the cosmetic effect. Therefore, on the premise of satisfactory exposure or guidance, how to integrate ultrasound and percutaneous interventional technology remained the focus of the exploration. This mini-review highlights and summarizes the signs of progress of ultrasound intervention in the last decade that have proven the effectiveness and operability of a well-established procedure for percutaneous closure of congenital heart diseases under echocardiographic guidance only. We discuss potential diseases that will benefit from this emerging procedure based on this progress. Owing to the crucial advantages played by this strategy in the treatment of CHD, better understanding and promotion of this less exploited field may contribute to the development of therapeutics targeting CHD, improve medical utilization rate, promote the optimization of medical resources, and ultimately achieve precise and efficient medical treatment.
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Affiliation(s)
- Ying Jiang
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Fanyan Luo
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Haisong Bu
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
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Bell-Cheddar Y, Devine WA, Diaz-Castrillon CE, Seese L, Castro-Medina M, Morales R, Follansbee CW, Alsaied T, Lin JHI. Double outlet right ventricle. Front Pediatr 2023; 11:1244558. [PMID: 37818164 PMCID: PMC10560996 DOI: 10.3389/fped.2023.1244558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/22/2023] [Indexed: 10/12/2023] Open
Abstract
This review article addresses the history, morphology, anatomy, medical management, and different surgical options for patients with double outlet right ventricle.
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Affiliation(s)
- Yolandee Bell-Cheddar
- Division of Pediatric Cardiac Critical Care, UPMC Children's Hospital of Pittsburgh , Pittsburgh, PA, United States
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - William A. Devine
- Department of Developmental Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | | | - Laura Seese
- Department of Pediatric Cardiothoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Mario Castro-Medina
- Department of Pediatric Cardiothoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Raymond Morales
- Division of Pediatric Cardiac Critical Care, Children's Hospital of New Orleans, New Orleans, LA, United States
| | - Christopher W. Follansbee
- Division of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Tarek Alsaied
- Division of Pediatric Cardiology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Jiuann-Huey I. Lin
- Division of Pediatric Cardiac Critical Care, UPMC Children's Hospital of Pittsburgh , Pittsburgh, PA, United States
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Mitral and aortic valve regurgitation following surgical and transcatheter perimembranous ventricular septal defect closure in children and adolescents: midterm outcomes. BMC Cardiovasc Disord 2022; 22:315. [PMID: 35840901 PMCID: PMC9287911 DOI: 10.1186/s12872-022-02757-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Closure of perimembranous ventricular septal defects (pmVSD), either surgical or percutaneous, might improve or cause new-onset mitral regurgitation (MR) and aortic regurgitation (AR). We aimed to evaluate the changes in MR and AR after pmVSD closure by these two methods. MATERIAL AND METHOD We performed a comparative retrospective data review of all pediatric patients with pmVSDs treated at our institution with surgical or antegrade percutaneous methods from 2014 to 2019 and 146 consecutive patients under 18 years were enrolled. We closely looked at the mitral and aortic valve function after repair. Included patients had no or lower than moderate aortic valve prolapse and baseline normal mitral or aortic valve function or less than moderate MR or AR. RESULTS Out of 146 patients, 83 (57%) pmVSDs were closed percutaneously, and 63 (43%) pmVSDs were closed surgically. 80 and 62 patients were included for MR evaluation, and 81 and 62 patients for AR evaluation in percutaneous and surgical groups. The mean follow-up time was 40.48 ± 21.59 months in the surgery group and 20.44 ± 18.66 months in the transcatheter group. Mild to moderate degrees of MR and AR did not change or decreased in most patients. In detail, MR of 70% and AR of 50% of the valves were resolved or decreased in both groups. 13% of patients with no MR developed trivial to mild MR, and 10% of patients with no AR showed mild to moderate AR after pmVSD closure in both methods. There was no significant difference between the two methods regarding emerging new regurgitation or change in the severity of the previous regurgitation. CONCLUSION pmVSD closure usually improves mild to moderate MR and AR to a nearly similar extent in both percutaneous and surgical methods among children and adolescents. It might lead to the onset of new MR or AR in cases with no regurgitation.
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Luo F, Bu H. How to reduce the risk of residual shunt during percutaneous treatment of ventricular septal defects. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:279. [PMID: 34815199 DOI: 10.1016/j.rec.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Fanyan Luo
- Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Haisong Bu
- Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha, P. R. China.
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Luo F, Bu H. Cómo reducir el riesgo de cortocircuito residual durante el cierre percutáneo de comunicación interventricular. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bu H, Yang Y, Wu Q, Hu S, Jin W, Gong X, Zhao T. Results of two different echocardiography-guided approaches to closure of perimembranous ventricular septal defects. Eur J Cardiothorac Surg 2021; 59:1304-1311. [PMID: 33532832 DOI: 10.1093/ejcts/ezab015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The feasibility of mini-invasive closure of perimembranous ventricular septal defects has been proven, but can cause surgical incision or sternum injury. A relevant but, to date, unanswered question is whether there exists a treatment without surgical trauma, radiation exposure and arterial complications. METHODS From May 2017 to January 2020, a total of 449 patients with perimembranous ventricular septal defect [mean age 5.0 ± 6.1 years (range 0.8-52.0 years)] were involved in this study and underwent 2 different echocardiography-guided operative procedures [percutaneous device closure (group A) or percardiac device closure (group B)] based on the patients' or their parents' choice. The clinical data were collected and a retrospective analysis was performed. RESULTS Fifty-five (96.5%) cases were successfully occluded in group A, and 2 (3.5%) patients were converted to percardiac device closure; 379 (96.7%) patients in group B underwent percardiac device closure, and 13 patients (3.3%) were turned to open-heart surgery after occlusion procedure failure. There were statistically significant differences (P < 0.05) between the 2 groups in operation time, postoperative hospitalization time and blood transfusion requirement. No acute complications or severe adverse events (death, valve injury, complete atrioventricular block and embolism) occurred either in the early period or during the follow-up. CONCLUSIONS Percutaneous device closure can achieve the same validity and safety as percardiac device closure for treating perimembranous ventricular septal defects with a more rapid recovery and less trauma.
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Affiliation(s)
- Haisong Bu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yifeng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qin Wu
- Department of Echocardiography, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shijun Hu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wancun Jin
- Department of Echocardiography, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xueyang Gong
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tianli Zhao
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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8
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Strategies to reduce complete heart block risk after device closure of ventricular septal defects. Int J Cardiol 2020; 320:77. [PMID: 32659290 DOI: 10.1016/j.ijcard.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 11/22/2022]
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Bu H, Yang Y. Comment on the article "Transcatheter closure of a perimembranous ventricular septal defect with Nit-Occlud Lê VSD Coil: A French multicentre study" by Ali Houeijeh et al. Arch Cardiovasc Dis 2020; 113:828-829. [PMID: 33168451 DOI: 10.1016/j.acvd.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/07/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Haisong Bu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, 139, Renmin Road, 410011 Changsha, Hunan, China
| | - Yifeng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, 139, Renmin Road, 410011 Changsha, Hunan, China.
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Hu X, Peng B. Asymmetric Occluder Occlusion of Outlet Ventricular Septal Defect Via a Subaxillary Approach. Ann Thorac Surg 2020; 112:1532-1536. [PMID: 33080233 DOI: 10.1016/j.athoracsur.2020.07.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/25/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Surgical transpleural minimally invasive occlusion of perimembranous and muscular ventral septal defects provides excellent results, but there is limited experience in outlet ventral septal defects (OVSDs) because of the specific anatomy and because OVSDs may occur with aortic valve prolapse. METHODS The procedure was performed in 84 children (mean age, 2.5 ± 2.3 years; mean weight, 12.1 ± 10.3 kg) between July 2014 and December 2018 at the Children's Heart Center of Henan Provincial People's Hospital. An approximately 2-cm right subaxillary incision was made, and the right ventricle was punctured under transesophageal echocardiographic guidance. The OVSD was occluded under transesophageal echocardiographic guidance with an asymmetric occluder. RESULTS Mean size of the OVSDs and the occluders was 4.6 ± 1.0 and 6.2 ± 1.2 mm, respectively. No patients died and no complications occurred, such as third-degree atrioventricular block, new aortic regurgitation, reoperation, or serious infection. All patients were observed for 32.1 ± 17.1 months. After surgery, there were 4 cases of residual shunt, which resolved spontaneously during follow-up. No complications, such as reoperation, aortic regurgitation, atrioventricular block, or occluder detachment, were observed during the follow-up period. CONCLUSIONS Occluding OVSDs using an asymmetric occluder through the subaxillary approach was safe and effective, with satisfactory short-term and mid-term results. Further follow-up is required regarding the long-term results.
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Affiliation(s)
- Xiaosong Hu
- Department of Cardiovascular Surgery, Henan Provincial People's Hospital, Fuwai Central Cardiovascular Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Bangtian Peng
- Department of Cardiovascular Surgery, Henan Provincial People's Hospital, Fuwai Central Cardiovascular Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
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Cichocki BN, Dugat DR, Baumwart RD. Pulmonary artery banding in a cat with a perimembranous ventricular septal defect and left-sided congestive heart failure. J Am Vet Med Assoc 2020; 254:723-727. [PMID: 30835177 DOI: 10.2460/javma.254.6.723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 6-month-old sexually intact male domestic shorthair cat was referred for evaluation of a heart murmur and ventricular septal defect (VSD). CLINICAL FINDINGS Physical examination revealed a grade 5/6 right apical systolic heart murmur. Findings on thoracic radiography were consistent with moderate right and left ventricular enlargement, left atrial enlargement, and enlargement of the pulmonary arteries and veins; an interstitial pulmonary pattern was also evident. Echocardiography revealed a perimembranous VSD with left-to-right shunting combined with trace mitral valve regurgitation. The cat later developed a dry cough, the intensity of the heart murmur increased to grade 6/6, and signs of left-sided congestive heart failure developed. TREATMENT AND OUTCOME Medical treatment included enalapril maleate and furosemide. When the cat's condition worsened despite medical treatment, palliative pulmonary artery banding was performed. During surgery, blood pressure in the pulmonary artery was measured with a pulmonary artery catheter, and pulmonary artery banding was successfully achieved with a polytetrafluoroethylene band and hemoclips. The pulmonary-to-systemic blood flow ratio was reduced from 3 to 1.5, and signs of congestive heart failure resolved within 2 weeks after surgery. CLINICAL RELEVANCE Findings suggested that cats with a VSD and pulmonary-to-systemic flow ratio > 3 or with congestive heart failure attributable to a VSD could be considered candidates for palliative pulmonary artery banding to alleviate clinical signs. However, further investigation into long-term prognosis with objective outcome measurements and with multiple cases is needed. (J Am Vet Med Assoc 2019;254:723-727).
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Li D, Zhou X, Li M, An Q. Comparisons of perventricular device closure, conventional surgical repair, and transcatheter device closure in patients with perimembranous ventricular septal defects: a network meta-analysis. BMC Surg 2020; 20:115. [PMID: 32456641 PMCID: PMC7249310 DOI: 10.1186/s12893-020-00777-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 05/18/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Treatments for perimembranous ventricular septal defects (pmVSD) mainly include conventional surgical repair (CSR), transcatheter device closure (TDC), and perventricular device closure (PDC). We aimed to perform a network meta-analysis to compare the three approaches in patients with pmVSD. METHODS We searched for comparative studies on device closure and conventional repair for pmVSD to April 2020. A network meta-analysis was performed under the frequentist frame with risk ratio and 95% confidence interval. The main outcome was the procedural success rate. Additional outcomes were postoperative complications, including residual shunt, intra-cardiac conduction block, valvular insufficiency, incision infection, and pericardial effusion. RESULTS Twenty-four studies of 8113 patients were included in the comparisons. The pooled estimates of success rate favored the CSR compared with the PDC. No significant differences of success rate were found in the TDC versus CSR and the PDC versus TDC. The pooled estimates of incidences of the residual shunt, new tricuspid regurgitation, incision infection, and pericardial effusion favored the PDC compared with the CSR. There were no significant differences between the PDC and TDC approaches in all outcomes except new aortic regurgitation. CONCLUSION The PDC technique not only reduces the risk of significant complications compared with the CSR, but also produces not inferior results compared with the TDC in selected pmVSD patients. PROSPERO REGISTRATION NUMBER CRD42019125257.
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Affiliation(s)
- Dongxu Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, P.R. China.
| | - Xu Zhou
- Evidence-based Medicine Research Center, School of Basic Medical Sciences, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, P.R. China
| | - Mengsi Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
| | - Qi An
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, P.R. China
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Liao Z, Chen H, Lin L, Chen Q, Chen L, Chen Z. Long-term outcomes after conventional surgical repair versus perventricular device occlusion for doubly committed subarterial ventricular septal defects: a propensity score matched study. Eur J Cardiothorac Surg 2020; 57:929-936. [PMID: 32163571 DOI: 10.1093/ejcts/ezaa020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/09/2019] [Accepted: 11/17/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the long-term outcomes of perventricular device occlusion and surgical repair for doubly committed subarterial ventricular septal defect using propensity score matched analysis because previous comparative studies were limited by differences in the baseline characteristics. METHODS We reviewed inpatients with isolated doubly committed subarterial ventricular septal defect aged <18 years who underwent surgical repair or device occlusion between January 2011 and December 2017. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics. RESULTS A total of 336 patients underwent surgical repair; 99 underwent device occlusion. After matching, the repair group included 164 patients, whereas the device group had 91 patients. There were no significant differences in the baseline characteristics. The median follow-up periods were 46 and 58 months for the device and repair groups, respectively. No significant difference was noted in the rates of cumulative adverse events in the 2 groups (7.9% vs 5.5%; P = 0.61). The repair group required longer periods of hospitalization (P = 0.002) and mechanical ventilation (P = 0.016). No grade 3 or higher valvular regurgitation or high-degree atrioventricular block events were observed. All patients were in sinus rhythm at the last follow-up examination. CONCLUSIONS In selected patients with doubly committed subarterial ventricular septal defect, compared with conventional repair, perventricular device occlusion has comparable efficacy and safety, less invasiveness in terms of time in the hospital and on mechanical ventilation and avoidance of cardiopulmonary bypass.
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Affiliation(s)
- ZhenMei Liao
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Hang Chen
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Li Lin
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Qiang Chen
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
| | - LiangLong Chen
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
| | - ZhaoYang Chen
- Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China
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Bu H, Yang Y, Wu Q, Zhao T. Percutaneous Puncture Closure of Postoperative Residual Ventricular Septal Defects Without Radiation. Ann Thorac Surg 2020; 109:e457-e459. [PMID: 32035048 DOI: 10.1016/j.athoracsur.2019.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/13/2019] [Accepted: 12/14/2019] [Indexed: 11/19/2022]
Abstract
A redo surgical approach to residual ventricular septal defect (VSD) is technically demanding. Sternum reentry has to be performed very carefully to avoid any uncontrolled bleeding, and preparation of the adhesions must be made to expose the most important structures (ascending aorta, caval veins). However, percutaneous transcatheter device closure of the residual VSD with radiation exposure can cause arrhythmia, valve injury, and vascular complications. This report presents a less invasive technique to treat residual VSD, without arterial access, radiation exposure, or cardiopulmonary bypass.
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Affiliation(s)
- Haisong Bu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yifeng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qin Wu
- Department of Echocardiography, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tianli Zhao
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
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A meta-analysis of perventricular device closure of doubly committed subarterial ventricular septal defects. J Cardiothorac Surg 2020; 15:28. [PMID: 31992348 PMCID: PMC6986052 DOI: 10.1186/s13019-020-1062-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/03/2020] [Indexed: 01/08/2023] Open
Abstract
Background To investigate the safety and efficacy of perventricular device closure of doubly committed subarterial ventricular septal defects (dcsVSDs). Methods PubMed and Scopus were searched for studies in English that focused on perventricular device closure of dcsVSDs and were published up to the end of September 2019. We used a random-effects model to obtain pooled estimates of the success and complication rates. Results A total of 9 publications including 459 patients with dcsVSDs were included. The median follow-up duration ranged from 2 months to 5 years, with the mean age of patients ranging from 6.1 months to 4.5 years. The pooled estimate of the overall success rate of device closure in the 9 studies was 0.89 (95% CI: 0.86–0.93, I2 = 26.5%, P = 0.208). Further meta-regression analysis indicated no significant correlation between the success rate and the following factors: publication year, sample size, study type, mean age, mean weight, mean VSD size, and ratio of device size/weight. The pooled rate of postoperative aortic regurgitation was 0.045 (95% CI: 0.018–0.071, I2 = 50.96%, P = 0.000). The pooled rate of follow-up aortic regurgitation (AR) was 0.001 (95% CI, − 0.003-0.004, I2 = 63.00%, P = 0.009.) The pooled estimated rate of severe intraoperative complications was 0.106 (0.073–0.140, I2 = 70.7%, P = 0.208). Postoperative and follow-up complications were rare. No occurrence of a complete atrioventricular block was reported up to the last follow-up visit. Conclusions Perventricular device closure may be an alternative to conventional surgical repair in selected patients with dcsVSDs. The success rate was stable regarding the publication year and sample size, suggesting a relatively short learning curve and the technique’s potential for application.
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Bu H, Yang Y, Hu S, Wu Q, Gong X, Zhao T. A novel biodegradable occluder for the closure of ventricular septal defects: immediate and medium-term results in a canine model. Interact Cardiovasc Thorac Surg 2019; 29:783-792. [PMID: 31321421 DOI: 10.1093/icvts/ivz174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/11/2019] [Accepted: 06/20/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The feasibility of an Amplatzer septal occluder closure of ventricular septal defects (VSDs) under echocardiographic guidance has already been proven. However, the technique is not used routinely owing to high-rate atrioventricular blocks and the non-absorbability of the occluder. Here, we aimed to evaluate the safety, biocompatibility and effectiveness of a new biodegradable occluder. METHODS A total of 18 adult beagle dogs [mean body weight 8.85 kg (range 8.10-10.40 kg)] were enrolled in our study from March 2015 to July 2018. VSD animal models were prepared by thoracic intervention, and the new bioabsorbable occluder was implanted under the guidance of transthoracic echocardiography. Laboratory examinations, transthoracic echocardiography and electrocardiography were performed after surgery, and pathological samples from dogs were obtained after euthanasia and examined in the 1st, 3rd, 6th, 9th, 12th and 24th months to evaluate the safety, biocompatibility and effectiveness of the biodegradable occluder. RESULTS All the dogs received successful implantations of the biodegradable occluder and survived, showing no follow-up-related complications (such as dislocation, arrhythmia and recanalization). Biochemical tests showed no significant abnormalities or differences, except for an increase in white blood cells and C-reactive proteins on the day after the operation. Histopathological examinations revealed that the bioabsorbable occluders were biocompatible, while immunohistochemical evaluations and electron microscopy showed endothelial cells growing on the occluder surface. CONCLUSIONS The effective occlusion of VSD, good biocompatibility, rapid endothelialization and lack of complications shown by the biodegradable occluder in this study suggest that the device meets acceptable clinical safety and has potential application prospects.
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Affiliation(s)
- Haisong Bu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yifeng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shijun Hu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qin Wu
- Department of Echocardiography, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xueyang Gong
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tianli Zhao
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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Bu H, Yang Y, Wu Q, Jin W, Zhao T. Echocardiography-guided percutaneous closure of perimembranous ventricular septal defects without arterial access and fluoroscopy. BMC Pediatr 2019; 19:302. [PMID: 31472688 PMCID: PMC6717354 DOI: 10.1186/s12887-019-1687-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 08/22/2019] [Indexed: 11/21/2022] Open
Abstract
Background Traditional percutaneous device closure of perimembranous ventricular septal defects (PmVSDs) is a minimally invasive technique, but can result in high radiation exposure and can result in potential arterial complications. Here, we aimed to assess the safety and feasibility of device closure of PmVSDs via the femoral vein approach under transesophageal echocardiography (TEE) guidance in children. Methods From January 2014 to December 2017, a total of 46 PmVSD patients (mean age, 6.5 ± 2.3 years [range, 4.2–12.0 years]; mean body weight 22.1 ± 6.6 kg [range, 16.0–38.5 kg]; VSD diameter, 4.1 ± 0.6 mm [range, 3.2–5.0 mm]) underwent attempted transcatheter closure via the femoral vein approach under the guidance of TEE without fluoroscopy. Results The transcatheter occlusion procedure under TEE guidance was successful in 44 (95.7%) patients. Surgery was necessary in 2 (4.3%) patients. The procedure duration was 28.2 ± 8.7 min (range, 12.0–42.0 min). One patient had immediate post-operative trivial residual shunt and three patients had immediate incomplete right bundle branch block (IRBBB) after operation; the new IRBBB in 1 case was noted in the first postoperative month. No residual shunt was noted at 3 months after the procedure, and no intervention related complications were detected at 1–24 months follow-up. Conclusions Percutaneous device closure of PmVSDs under TEE guidance solely by femoral vein approach is effective and safe, avoids radiation exposure, potential arterial complications and a surgical incision. Electronic supplementary material The online version of this article (10.1186/s12887-019-1687-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Haisong Bu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Yifeng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Qin Wu
- Department of Echocardiography, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Wancun Jin
- Department of Echocardiography, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Tianli Zhao
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.
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Zhang F, Yang Y, Wu Q, Jin W, Bu H, Wu S, Zhao T, Hu S. Strategy of treating secundum atrial septal defect not referred to percutaneous closure. CONGENIT HEART DIS 2019; 14:324-330. [PMID: 30714327 DOI: 10.1111/chd.12753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate safety and effectiveness of intraoperative device closure for secundum atrial septal defect (ASD) not referred to percutaneous closure. DESIGN AND PATIENTS From April 2010 to December 2018, 231 secundum ASD children (≤14 years) directly recommended to surgical repair were enrolled in this study. These patients were divided into two groups according to the parents' choice based on surgeons' recommendation. Follow-up evaluations were adopted at 2 weeks, 3 months, 6 months, and 12 months after the procedure and yearly thereafter. In Group A, 127 patients underwent an initial attempt at device closure. In Group B, 104 patients underwent a repair procedure under cardiopulmonary bypass. RESULTS All patients survived. Group A had lower values of operation time, mechanical ventilation time, cardiac intensive care unit duration and amount of blood transfusion. Nevertheless, postoperative hospitalization time between two groups showed no statistical difference. In group A, 109 (85.83%) patients were successfully occluded, whereas 18 (14.17%) patients were converted to open-heart surgery. No severe complications occurred in the follow-up period. CONCLUSION Intraoperative device closure is safe, effective procedure for selected cases with secundum ASDs which were not referred to percutaneous closure because of more suitable occluder selection, no "unbutton effect" and stitching enhancement.
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Affiliation(s)
- Fei Zhang
- NanShan people's hospital of ShenZhen, P.R. China
| | - Yifeng Yang
- Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Qin Wu
- Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Wancun Jin
- Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Haisong Bu
- Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Sijie Wu
- Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Tianli Zhao
- Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, P.R. China
| | - Shijun Hu
- Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, P.R. China
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Hu X, Peng B, Zhang Y, Ai F, Zheng J. Short-Term and Mid-Term Results of Minimally Invasive Occlusion of Ventricular Septal Defects via a Subaxillary Approach in a Single Center. Pediatr Cardiol 2019; 40:198-203. [PMID: 30298227 DOI: 10.1007/s00246-018-1980-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 09/01/2018] [Indexed: 10/28/2022]
Abstract
This retrospective, single-center study evaluated short-term and mid-term results of minimally invasive surgery to occlude ventricular septal defects (VSDs) using a subaxillary approach. The procedure was performed on 429 children (224 boys, 205 girls; age 2.4 ± 2.5 years; mean weight 12.7 ± 10.1 kg) between January 2014 and December 2016 at the Children's Heart Center of Henan Province People's Hospital. An approximately 2-cm subaxillary incision was made between the third and fifth ribs, and the appropriate right atrium or ventricle was punctured under the guidance of transencephalographic echocardiography (TEE). The VSD was then occluded under TEE guidance. The mean size of the VSDs was 4.2 ± 1.0 mm, and the occluder measured 5.3 ± 1.3 mm. Asymmetrical occluders were used in 44 patients and symmetrical occluders in 385 patients. The operative time was 60.7 ± 21.3 min, and time in the intensive care unit was 20.9 ± 6.5 h. Blood loss was 12.4 ± 14.4 ml. There were no deaths among these patients. Occluder displacement occurred in two cases. There were no complications (e.g., third-degree atrioventricular block, new aortic regurgitation, reoperation for massive bleeding, serious infection). All patients were followed for 6-48 months, during which time there were ten cases of a postoperative residual shunt, which self-closed in eight during follow-up. The other two cases are still being followed. No complications occurred during follow-up (e.g., reoperation, aortic regurgitation, atrioventricular block, occluder abscission). Occluding VSDs using the subaxillary approach is safe and effective. Short-term and mid-term results are satisfactory. Further follow-up is required regarding long-term results.
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Affiliation(s)
- Xiaosong Hu
- Department of Pediatric Cardiac Surgery, Henan Provincial People's Hospital, Fuwai Central Cardiovascular Hospital, People's Hospital of Zhengzhou University, No. 7 Weiwu Road Jinshui District, Zhengzhou, 450003, Henan, People's Republic of China
| | - Bangtian Peng
- Department of Pediatric Cardiac Surgery, Henan Provincial People's Hospital, Fuwai Central Cardiovascular Hospital, People's Hospital of Zhengzhou University, No. 7 Weiwu Road Jinshui District, Zhengzhou, 450003, Henan, People's Republic of China.
| | - Yanwei Zhang
- Department of Pediatric Cardiac Surgery, Henan Provincial People's Hospital, Fuwai Central Cardiovascular Hospital, People's Hospital of Zhengzhou University, No. 7 Weiwu Road Jinshui District, Zhengzhou, 450003, Henan, People's Republic of China
| | - Feng Ai
- Department of Pediatric Cardiac Surgery, Henan Provincial People's Hospital, Fuwai Central Cardiovascular Hospital, People's Hospital of Zhengzhou University, No. 7 Weiwu Road Jinshui District, Zhengzhou, 450003, Henan, People's Republic of China
| | - Jiayong Zheng
- Department of Pediatric Cardiac Surgery, Henan Provincial People's Hospital, Fuwai Central Cardiovascular Hospital, People's Hospital of Zhengzhou University, No. 7 Weiwu Road Jinshui District, Zhengzhou, 450003, Henan, People's Republic of China
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Liu H, Lu FX, Zhou J, Yan F, Qian SC, Li XY, Zheng SQ, Chen JQ, Zhong JS, Feng QL, Ding T, Fan J, Gu HT, Liu XC. Minimally invasive perventricular versus open surgical ventricular septal defect closure in infants and children: a randomised clinical trial. Heart 2018; 104:2035-2043. [DOI: 10.1136/heartjnl-2017-312793] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/21/2018] [Accepted: 05/30/2018] [Indexed: 11/04/2022] Open
Abstract
BackgroundRobust evidence is lacking regarding the clinical efficacy, safety and cardiopulmonary performance of perventricular closure. This study investigated the perioperative efficacy, safety and cardiorespiratory performance of perventricular closure of perimembranous ventricular septal defects (pmVSDs).MethodsOperation-naïve infants and young children aged 5–60 months with isolated pmVSDs were randomised to receive either standard open surgical or minimally invasive perventricular closure via direct entry into the ventricle with a catheter from a subxiphoid incision. The primary outcomes included complete closure at discharge, major and minor adverse events and the changes in perioperative cardiorespiratory performance from baseline. Complete closure was mainly analysed in the modified intention-to-treat (mITT) population, with sensitivity analyses for the ITT, per-protocol (PP) and as-treated (AT) populations (non-inferiority margin −5.0%).ResultsWe recruited 200 patients with pmVSDs for this study (mean age 24.38 months, range 7–58 months, 104 girls), of whom 100 were randomly allocated to one of the study groups. The non-inferiority of perventricular to surgical closure regarding complete closure at discharge was not shown in the ITT (absolute difference −0.010 (95% CI −0.078 to 0.058)) and mITT populations (−0.010 (95% CI −0.069 to 0.048)), but was shown in the PP (0.010 (95% CI −0.043 to 0.062)) and AT populations (0.048 (95% CI −0.009 to 0.106)). Perventricular closure reduced the rate of compromising cardiac haemodynamics, electrophysiological responses, cardiomyocyte viability, respiratory mechanics, ventilatory and gas exchange function and oxygenation and tissue perfusion compared with surgical closure (all between-group P<0.05).ConclusionsFor infants and young children with pmVSD, perventricular closure reduced the rate of postoperative cardiorespiratory compromise compared with surgical closure, but the non-inferiority regarding complete closure should be interpreted in the context of the specific population.Trial registration numberNCT02794584 ;Results.
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Ou-Yang WB, Wang SZ, Hu SS, Zhang FW, Zhang DW, Liu Y, Meng H, Pang KJ, Meng LK, Pan XB. Perventricular device closure of perimembranous ventricular septal defect: effectiveness of symmetric and asymmetric occluders. Eur J Cardiothorac Surg 2017; 51:478-482. [PMID: 28082474 DOI: 10.1093/ejcts/ezw352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/19/2016] [Indexed: 12/17/2022] Open
Abstract
Objectives To assess safety and effectiveness of symmetric and asymmetric occluders in perventricular device closure without cardiopulmonary bypass of perimembranous ventricular septal defects (pmVSDs). Methods The present retrospective study enrolled 581 patients who underwent perventricular device closure of pmVSDs under transoesophageal echocardiography guidance from May 2011 to April 2016, and outpatient electrocardiography and transthoracic echocardiography assessments at 1, 3, 6 and 12 months, and yearly thereafter. Results The overall success rate of device implantation was 92.6% (43 surgical conversions immediately). Between patients receiving symmetric ( n = 353) and asymmetric ( n = 185) occluders, there were no significant differences in age, weight and defect diameter distributions; however, both before discharge and at mean 28.6 ± 21.2 (range, 1-60)-month follow-up, the symmetric group had lower rates of trivial residual shunt (5.7% vs 11.4%, P = 0.018; and 0.8% vs 5.9%, P = 0.001) and bundle branch block (0.8% vs 5.4%, P = 0.002; and 0.6% vs 3.8%, P = 0.009); and at follow-up, the asymmetric group had lower residual shunt (47.6% vs 85.0%, P = 0.020) and similar branch block (30.0% vs 33.3%, P = 1.000) disappearance rates. There were no severe complications, i.e. aortic regurgitation, malignant arrhythmias, haemolysis or device dislocation. Conclusions Perventricular device closure of pmVSDs appears safe and effective with symmetric and asymmetric occluders. However, the lower residual shunt disappearance and higher branch block incidence rates for asymmetric occluders would favour more proactive conversion to surgical repair immediately when residual shunt is present intraoperatively.
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Affiliation(s)
- Wen-Bin Ou-Yang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China.,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Shou-Zheng Wang
- Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Innovation Center of Major Infectious Diseases, Beijing, China
| | - Sheng-Shou Hu
- Department of Psychology, National Cheng Kung University, Tainan, Taiwan
| | - Feng-Wen Zhang
- Key Laboratory of Adaptation and Evolution of Plateau Biota, Northwest Institute of Plateau Biology, Chinese Academy of Sciences, Xining, China
| | - Da-Wei Zhang
- State Key Laboratory of ASIC and System, School of Microelectronics, Fudan University, Shanghai, China
| | - Yao Liu
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg, Netherlands
| | - Hong Meng
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Kun-Jing Pang
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China.,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Liu-Kun Meng
- Gene Oasis Research and Innovation, Singapore Tianjin University, Tianjin, PR China
| | - Xiang-Bin Pan
- Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, China.,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
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22
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Zhou Y, Liu LX, Zhao F, Tang SH, Peng HL, Jiang YH. Effects of transthoracic device closure on ventricular septal defects and reasons for conversion to open-heart surgery: A meta-analysis. Sci Rep 2017; 7:12219. [PMID: 28939836 PMCID: PMC5610181 DOI: 10.1038/s41598-017-12500-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/08/2017] [Indexed: 12/30/2022] Open
Abstract
Transthoracic device closure (TTDC) is thought to be a promising technology for the repair of ventricular septal defects (VSDs). However, there is considerable controversy regarding the efficacy and safety of TTDC. The present study aimed to compare the benefits and safety of TTDC with those of conventional open-heart surgery (COHS) and analyze the associated factors causing complications, conversion to COHS and reoperation. Electronic database searches were conducted in PubMed, EMBASE, Cochrane Library, Clinicaltrials.gov and several Chinese databases. A total of 5 randomized controlled trials (RCTs), 7 cohort studies, 13 case-control studies, 129 case series and 13 case reports were included. Compared to COHS, TTDC exhibited superior efficacy with a significantly lower risk of post-operative arrhythmia; however, no significant differences in other outcomes were identified. Meta-regression analysis showed that perimembranous VSDs (pmVSDs), a smaller VSD, a smaller occluder, and a median or subxiphoid approach lowered the relative risk of several post-operative complications, conversion to COHS and reoperation. The current evidence indicates that TTDC is associated with a lower risk of post-operative arrhythmia and is not associated with an increased risk of complications. PmVSDs, a smaller VSD and occluder, and a median or subxiphoid approach correlate with better outcomes when using TTDC.
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Affiliation(s)
- Yang Zhou
- Department of Cardiothoracic Surgery, the People's Hospital of Leshan, Leshan, Sichuan Province, 614000, P.R. China
| | - Ling-Xi Liu
- Department of Cardiothoracic Surgery, the People's Hospital of Leshan, Leshan, Sichuan Province, 614000, P.R. China
| | - Fei Zhao
- Department of Cardiothoracic Surgery, the People's Hospital of Leshan, Leshan, Sichuan Province, 614000, P.R. China
| | - Shi-Hai Tang
- Department of Cardiothoracic Surgery, the People's Hospital of Leshan, Leshan, Sichuan Province, 614000, P.R. China
| | - Hua-Li Peng
- Department of Cardiothoracic Surgery, the People's Hospital of Leshan, Leshan, Sichuan Province, 614000, P.R. China
| | - Yun-Han Jiang
- Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing, Chongqing, 400030, P.R. China.
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Liao Y, Long X, Zhu S, Tu J, Wen H, Xu J, Wu Y. Minimally access via left anterior mini-thoracotomy for repair of adult subarterial ventricular septal defects. J Cardiothorac Surg 2017; 12:48. [PMID: 28606107 PMCID: PMC5469133 DOI: 10.1186/s13019-017-0611-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background Minimally invasive cardiac surgical techniques are increasingly applied in the treatment and management of a variety of adult ventricular septal defects (VSDs). However, repair of adult subarterial VSDs via left anterior mini-thoracotomy is rarely reported. The present study aimed to determine the feasibility and safety of the left anterior mini-thoracotomy for the repair of adult subarterial VSDs. Methods Twenty-seven adult patients underwent repair of subarterial VSDs via left anterior mini-thoracotomy. The approach includes two options for skin incision access, longitudinal and transverse skin incisions. The skin incision length was 4.1–6.1 cm (mean, 5.1 ± 0.6 cm). The closure of the VSDs was obtained through the main pulmonary artery under direct visualization. Results Successful repair of the defects was achieved in all the patients. No patients died or converted to median sternotomy. Average durations of cardiopulmonary bypass (CPB) and aortic cross-clamp were 102.5 ± 13.6 min (range, 85–127 min) and 54.6 ± 6.9 min (range, 45–66 min), respectively. No patients required blood transfusion. The average postoperative hospital stay was 5.1 ± 0.7 days (range, 4–6 days). There were no postoperative complications related to the operative procedures or peripheral cannulation. During the follow-up of 5.4–32.3 months, no patients were found to have residual shunt, wound infections, pericardial effusion, neurologic or other complications. Conclusion Our experiences demonstrate that minimally invasive cardiac surgical technique via left anterior mini-thoracotomy can be served as a novel, feasible and safe alternative for the repair of adult subarterial VSDs.
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Affiliation(s)
- YunFei Liao
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - Xiang Long
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - ShuQiang Zhu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - Jun Tu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - Hua Wen
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - JianJun Xu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China
| | - YongBing Wu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, People's Republic of China.
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Cao H, Chen Q, Zhang GC, Chen LW, Qiu ZH, Xu F. Transthoracic Subarterial Ventricular Septal Defect Occlusion Using a Minimally Invasive Incision. J Card Surg 2016; 31:398-402. [PMID: 27132625 DOI: 10.1111/jocs.12754] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study sought to investigate the feasibility of transthoracic occlusion of a subarterial ventricular septal defect using a minimally invasive incision. METHODS Between January 2009 and June 2014, we performed transthoracic subarterial ventricular septal defect occlusion for 81 patients via a minimally invasive incision. A special delivery sheath was used during surgery, and an eccentric occluder was implanted in the ventricular septal defect. RESULTS Successful defect closure was achieved in 74 cases, perioperative arrhythmia occurred in five cases, and a large pericardial effusion was observed in two cases. Open heart surgery was performed for two patients to repair postoperative dislocation of the occluder. Intraoperative conversion to surgical repair was required in seven cases. During one to five years of follow-up, there was no late occluder dislocation, residual leakage, or thrombus-related complications. CONCLUSIONS Transthoracic subarterial ventricular septal defect occlusion using a minimally invasive incision may be an alternative to open surgical repair in selected patients. doi: 10.1111/jocs.12754 (J Card Surg 2016;31:398-402).
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Affiliation(s)
- Hua Cao
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Gui-Can Zhang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Zhi-Huang Qiu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Fan Xu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P.R. China
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Zhao Yang C, Hua C, Yuan Ji M, Qiang C, Wen Zhi P, Wan Hua C, Chang X, Lin F, Liang-Long C, Jun Bo G. Transfemoral and Perventricular Device Occlusions and Surgical Repair for Doubly Committed Subarterial Ventricular Septal Defects. Ann Thorac Surg 2015; 99:1664-70. [DOI: 10.1016/j.athoracsur.2015.01.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/30/2014] [Accepted: 01/06/2015] [Indexed: 10/23/2022]
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Prêtre R. Subaortic ventricular septal defect closure: is the principle of harmony for a longer function no longer valid? Eur J Cardiothorac Surg 2014; 46:654-5. [PMID: 24652815 DOI: 10.1093/ejcts/ezu125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- René Prêtre
- Cardiac Surgery Unit, University Hospital of Lausanne, Lausanne, Switzerland
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