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Adilbekova A, Marassulov S, Baigenzhin A, Kozhakhmetov S, Nurkeyev B, Kerimkulov A, Murzabayeva S, Maiorov R, Kenzhebayeva A. Hybrid versus traditional method closure of ventricular septal defects in children. JTCVS Tech 2024; 24:137-144. [PMID: 38835571 PMCID: PMC11145337 DOI: 10.1016/j.xjtc.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/23/2023] [Accepted: 01/12/2024] [Indexed: 06/06/2024] Open
Abstract
Objective The aim of our study was to evaluate the safety and effectiveness of the hybrid method off-pump for closure of isolated ventricular septal defect (VSD) compared with the traditional method of on-pump of children. Methods This research was a retrospective cohort study. Data were collected from 500 patients with isolated VSD (or residual VSD after a previous repair) who underwent surgery at the National Scientific Medical Center from May 2016 to December 2020. Patients were operated with 1 of 2 methods of surgery: the traditional method of on-pump or the hybrid method of off-pump. This study assessed the safety and efficacy of the hybrid method by comparing it with the traditional method for the treatment of patients with isolated VSD. Results The procedural success rate reached 93.2% in the hybrid method, with a 6.4% conversion rate to the traditional method and 0.4% hospital mortality. The mean operation time was 84 minutes (31; 160 minutes) in the hybrid group (n = 250) and 168 minutes (70; 300 minutes) in the traditional group (n = 250) (P = .000). Hospital mortality was 0.43% in the first group and 1.5% in the second group (P = .000). Conclusions The hybrid method of VSD closure is safe and effective in a selected group of patients. The advantages of the hybrid method are improved cosmetics and shorter operation time and overall hospital stay.
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Affiliation(s)
- Akkerbez Adilbekova
- Department of Pediatric Cardiac Surgery, National Scientific Medical Center, Astana City, Republic of Kazakhstan
- Department of Surgical Diseases Named Tsoi, Аstana Medical University, Astana City, Republic of Kazakhstan
| | - Shukhrat Marassulov
- Department of Pediatric Cardiac Surgery, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Abay Baigenzhin
- Department of Pediatric Cardiac Surgery, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Saken Kozhakhmetov
- Department of Surgical Diseases Named Tsoi, Аstana Medical University, Astana City, Republic of Kazakhstan
| | - Bakhytzhan Nurkeyev
- Department of Pediatric Cardiac Surgery, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Amangeldy Kerimkulov
- Department of Pediatric Anesthesiology, Reanimation and Intensive Care, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Saniya Murzabayeva
- Department of Pediatric Anesthesiology, Reanimation and Intensive Care, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Rinat Maiorov
- Department of Pediatric Interventional Cardiology, Endovascular X-ray Surgery and Functional Diagnostics, National Scientific Medical Center, Astana City, Republic of Kazakhstan
| | - Arailym Kenzhebayeva
- Department of Pediatric Cardiac Surgery, National Scientific Medical Center, Astana City, Republic of Kazakhstan
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Elmarsafawy H, Hafez M, Alsawah GA, Bakr A, Rakha S. Long-term outcomes of percutaneous closure of ventricular septal defects in children using different devices: A single centre experience from Egypt. BMC Pediatr 2023; 23:381. [PMID: 37525132 PMCID: PMC10392015 DOI: 10.1186/s12887-023-04194-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND The feasibility of percutaneous closure ventricular septal defects (VSD) in children has been previously proven. However, data on long-term outcomes are limited. We aim to evaluate the long-term outcome of our experience with percutaneous closure of VSD using various occluders. METHODS Retrospective institutional analysis of children who underwent transcatheter closure of perimembranous and muscular VSDs between September 2012 and February 2020. Patient demographics, procedural, and long-term follow-up data were comprehensively analyzed. Patients who lost to follow-up within two years post-procedure were excluded. RESULTS We identified 75 patients (54.7% males) with a median of 66 months (IQR, 46-96). The closure success rate at one year was 95.7%. Complete heart block was detected in two patients early post-procedure and resolved with steroids. The VSDs were perimembranous (52%), muscular (33.33%), and residual (14.67%). Implanted devices were Pfm Nit-Occlud LeˆVSD Coil (42.7%), HyperionTM VSD Muscular Occluder (28%), Amplatzer VSD muscular occluder (10.7%), Amplatzer Duct Occluder (14.7%), Occlutech Muscular VSD Occluder (2.7%), and Amplatzer Duct Occluder II (1.3%). No new arrhythmia or valve regurgitation was detected after two years post-procedure. Persisted complications on long-term follow-up included: residual shunting in 3(4%), mild tricuspid regurgitation in 2(2.7%), and aortic regurgitation in 2(2.7%), with one immediate post-catheterization mild aortic regurgitation worsened during follow-up, requiring surgical repair of VSD three years after device implantation. No deaths were reported. CONCLUSION Long-term outcomes of pediatric transcatheter VSD closure using different devices are satisfactory. Post-procedural adverse events are limited, but long-term surveillance is necessary to monitor their progression.
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Affiliation(s)
- Hala Elmarsafawy
- Pediatric Cardiology Unit, Pediatrics Department, Mansoura University Faculty of Medicine, El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
- Faculty of Medicine, New Mansoura University, New Mansoura City, Egypt
| | - Mona Hafez
- Pediatric Cardiology Unit, Pediatrics Department, Mansoura University Faculty of Medicine, El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
| | - Gehan A Alsawah
- Pediatric Cardiology Unit, Pediatrics Department, Mansoura University Faculty of Medicine, El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
| | - Asmaa Bakr
- Pediatric Cardiology Unit, Pediatrics Department, Mansoura University Faculty of Medicine, El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt
| | - Shaimaa Rakha
- Pediatric Cardiology Unit, Pediatrics Department, Mansoura University Faculty of Medicine, El Gomhouria St, Mansoura, Dakahlia Governorate, 35516, Egypt.
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Ling Q, Zhao S, Shi Y, Li X, Li P, Zhao G, Zhu Q. Transversus Thoracis Muscle Plane Block in Paediatric Patients Who Underwent Minimally Invasive Closure of Transthoracic Ventricular Septal Defect: A Retrospective Study. Pain Res Manag 2023; 2023:3488552. [PMID: 36999119 PMCID: PMC10049843 DOI: 10.1155/2023/3488552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/01/2023]
Abstract
Objective Minimally invasive closure of transthoracic ventricular septal defect (VSD) has been widely used in paediatric patients. This retrospective study aimed to explore the use of transversus thoracis muscle plane block (TTMPB) in the minimally invasive closure of transthoracic VSD in paediatric patients. Methods From September 28, 2017, to July 25, 2022, a total of 119 paediatric patients scheduled for minimally invasive transthoracic VSD closure were considered for inclusion. Results In total, 110 patients were included in the final analysis. Perioperative fentanyl consumption of the TTMPB group was not different from that of the non-TTMPB group (5.90 ± 1.32 μg/kg vs. 6.25 ± 1.74 μg/kg, p = 0.473). Both the time to extubation and postanesthesia care unit (PACU) stay were significantly shorter in the TTMPB group than in the non-TTMPB group (10.94 ± 10.31 min vs. 35.03 ± 23.52 min for extubation, and 42.55 ± 16.83 min vs. 59.98 ± 27.94 min for PACU stay, both p < 0.001). Furthermore, the postoperative paediatric intensive care unit (PICU) stay in the TTMPB group was significantly shorter than in the non-TTMPB group (1.04 ± 0.28 d vs. 1.34 ± 1.05 d, p = 0.005). Multivariate analysis demonstrated that TTMPB was significantly associated with shorter time to extubation (p < 0.001) and PACU stay (p = 0.001) but not postoperative PICU stay (p = 0.094). Discussion. This study showed that TTMPB was a beneficial and safe regional anaesthesia technique for paediatric patients who underwent minimally invasive closure of transthoracic VSD, although prospective randomized controlled trials are needed to confirm the results.
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Affiliation(s)
- Qiong Ling
- 1Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuhua Zhao
- 2Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Yongyong Shi
- 1Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangyu Li
- 1Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ping Li
- 1Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Gaofeng Zhao
- 1Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qianqian Zhu
- 2Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
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Application of the WeChat platform in midterm follow-up after surgical repair of ventricular septal defects in infants. Cardiol Young 2022; 32:728-731. [PMID: 34325770 DOI: 10.1017/s1047951121002870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To explore the feasibility and superiority of applying the WeChat platform in a midterm follow-up of surgical repair for ventricular septal defects in infants. METHODS Eighty-six infants with VSD who underwent surgical repair were divided into an outpatient follow-up group and a WeChat follow-up group. The clinical data, including complications, economic cost, time spent, loss to follow-up rate, and parents' satisfaction at the 3-month and 1-year follow-ups, were recorded and analysed. RESULTS There was no significant difference in the incidence of post-operative complications between the two groups. Although the loss to follow-up rate in the WFU group was lower than that of the OFU group, the difference was not statistically significant. The economic cost and time spent in the 3 months and 1 year after discharge in the WFU group were significantly lower than those in the OFU group. One year after discharge, the PSQ-18 score of the WFU group was significantly higher than that of the OFU group. CONCLUSION Compared with outpatient follow-up, the WeChat platform at the midterm follow-up after surgical repair of VSDs in infants has the advantages of saving time and economic costs and improves parents' satisfaction.
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Zhu J, Zhang Y, Bao C, Ding F, Mei J. Individualized strategy of minimally invasive cardiac surgery in congenital cardiac septal defects. J Cardiothorac Surg 2022; 17:5. [PMID: 35033146 PMCID: PMC8761281 DOI: 10.1186/s13019-022-01753-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background Intracardiac septal defect is repaired using median sternotomy in most centers; however, there are several reports using minimally invasive surgery in both children and adults. This study summarized our strategy of minimally invasive therapy using various lateral mini-thoracotomies in patients with congenital septal defect. Methods In this study, 472 patients who underwent minimally invasive repair of intracardiac septal defects (atrial septal defect, (ASD), ventricular septal defect, (VSD), and atrioventricular septal defect, (AVSD)) from January 2012 to June 2020 were retrospectively reviewed. Those who underwent device closure were excluded. The minimally invasive strategy included three groups: the right sub-axillary vertical incision (RSAVI) group (N = 335, including192 ASDs, 135 VSDs and 8 AVSDs); the right anterolateral thoracotomy (RALT) group (N = 132, including 77 ASDs, 51 VSDs and 4 AVSDs); and the left anterolateral thoracotomy (LALT) group (N = 5, all subpulmonary VSDs). Results Concomitant surgeries included nine cases of right ventricular outflow tract obstruction relief, nine cases of mitral repairs and 37 cases of tricuspid repairs. There was one transition from thoracotomy to sternotomy. Three patients required second pump run for residual lesions (two residual VSD shunts and one mitral regurgitation). The age and body weight of the RSAVI group were significantly lower than those of the RALT and LALT groups (all P < 0.01). No postoperative death was observed. Postoperative complications included one case of chest exploration for bleeding, one case of reoperation due to patch dehiscence during the same admission, one case of transient neural dysfunction, three cases of diaphragmatic paresis and 13 cases of atelectasis. The median stay in the intensive care unit was two days, while the median postoperative hospitalization duration was six days. The echocardiography results before discharge indicated no significant residual lesions. No reoperation, no new onset of chest deformities and no sclerosis were observed during the follow-up. Conclusions Intracardiac septal defects can be safely and effectively repaired by minimally invasive surgery with good cosmetic results. RSAVI is suitable in infants and children, while RALT is more commonly used in adolescents and adults. LALT is an alternative incision to repair subpulmonary VSD.
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Affiliation(s)
- Jiaquan Zhu
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Yunjiao Zhang
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Chunrong Bao
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Fangbao Ding
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Ju Mei
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
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Transcarotid Approach to Ventricular Septal Defect Closure in Small Infants. Pediatr Cardiol 2021; 42:1539-1545. [PMID: 34081172 DOI: 10.1007/s00246-021-02638-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
Perimembranous ventricular septal defect closure in small infants has traditionally been a surgically treated defect, although alternative hybrid strategies are emerging. We aim to describe a novel approach to retrograde device closure of clinically relevant perimembranous ventricular septal defects in small infants via carotid cutdown. A retrospective review of all patients managed with attempted carotid cutdown for device closure of a perimembranous ventricular septal defect was recorded at a single tertiary cardiac centre. We summarized data on successful device deployment, conversion to open repair, complications, and length of stay. Eighteen infants with median (IQR) age of 7 months (5-9 months) and weight of 7.1 kg (6.5-7.8 kg) with clinically relevant PMVSD underwent attempted retrograde closure via carotid cutdown. Median (IQR) defect size was 8 mm (7-9 mm). Successful device deployment without significant aortic or tricuspid valve interference occurred in 15 (83%) patients. Three patients were converted to open repair, one following damage to the tricuspid valve apparatus. Median (IQR) hospital stay was 1 day (1-3 days). There were no complications related to carotid cutdown. Retrograde device closure of hemodynamically significant PMVSD is feasible and effective in small infants. Decision to convert to surgical repair should be made early if suboptimal device placement occurs. Carotid evaluation should be performed to rule out any access-related complications.
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Transesophageal echocardiography-guided device occlusion of ventricular septal defects: a propensity score matching analysis of left anterior mini-thoracotomy vs. lower partial median sternotomy. Chin Med J (Engl) 2021; 134:2747-2749. [PMID: 34845996 PMCID: PMC8631375 DOI: 10.1097/cm9.0000000000001514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
BACKGROUND Medical advancements have encouraged minimally invasive surgical repair of congenital heart defects such as ventricular septal defects (VSDs), and the diagnostic process can now be carried out using non-traditional techniques such as pulse oximetry. This, in turn, has improved clinical outcomes with reduced complication rates post-surgery. However, the variations in type of VSDs, age of patient, comorbidities, and access to closure devices may limit the efficacy of surgical advancements. METHODS Articles were identified amongst Scopus, MEDLINE, and PubMed using various relevant search strings using PRISMA guidelines. Of the 115 articles initially extracted, 10 were eventually reviewed after duplicates and irrelevant studies were removed. RESULTS Of the 24 eligible articles, 10 papers were selected for analysis. Minimally invasive approaches to VSD repair was associated with satisfactory short-term outcomes when compared to open repair. For diagnosis of congenital VSD, whilst recent advances such as pulse oximetry method and genome analysis are more sensitive, the limited availability and access to such investigatory methods must be recognised. CONCLUSION Pulse oximetry and fetal echocardiography are established non-invasive diagnostic tools for VSD. The recent advances in minimally invasive treatment options including periventricular approach and transcatheter techniques have improved patient outcomes, yet at the expense of higher residual rates. Careful patient selection for each technique and follow-up should be planned through multidisciplinary team meetings.
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Lu W, Zhang F, Fan T, Zhao T, Han Y, Hu X, Li Q, Shi H, Pan X. Minimally-invasive-perventricular-device-occlusion versus surgical-closure for treating perimembranous-ventricular-septal-defect: 3-year outcomes of a multicenter randomized clinical trial. J Thorac Dis 2021; 13:2106-2115. [PMID: 34012561 PMCID: PMC8107524 DOI: 10.21037/jtd-20-3298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Minimally-invasive-perventricular-device-occlusion (MIPDO) combined superiority of surgical-repair and percutaneous-device-closure in treating perimembranous-ventricular-septal-defect (pmVSD). This study was to evaluate the efficacy and safety of MIPDO for treating pmVSD, comparing with surgical-repair. Methods Patients aged ≥3 months with isolated pmVSDs were randomized to undergo either surgical or MIPDO procedure, with the median follow-up time of 49 months. The primary outcome was the rate of complete pmVSD closure at discharge. The secondary outcomes included the adverse events during hospitalization and follow-up, chest tube output volume, blood transfusion volume, procedural duration, ventilation time, hospitalization duration and hospitalization cost. Also, perioperative cardiac performance and systemic conditions were evaluated. Results Of the 313 patients (9 months to 42 years old; median, 4 years old) with pmVSDs recruited from 3 centers, 100 were finally enrolled and randomly allocated 1:1 into two groups. The non-inferiority (non-inferiority margin -8.0%) of MIPDO to surgical closure regarding efficacy was shown in both intention-to-treat (0, 95% CI: -0.055 to 0.055) and per-protocol populations (0.02, 95% CI: -0.018 to 0.058). Although the rate of adverse events was similar between groups, the MIPDO group showed superiority in procedural duration, ventilation time, chest tube output volume, postoperative hospitalization time and hospitalization cost compared with surgical group (P<0.05). Moreover, MIPDO method showed comparable perioperative cardiac performance with milder change of systemic condition. Conclusions In patients with pmVSDs, MIPDO method showed non-inferiority to surgical closure in efficacy for both intention-to-treat and per-protocol population with easier perioperative recovery, economic benefit and promising outcomes.
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Affiliation(s)
- Wenxin Lu
- Structural Heart Disease Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengwen Zhang
- Structural Heart Disease Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Taibing Fan
- Heart Center of Henan Provincial People's Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Tianli Zhao
- The Central South University, Changsha, China
| | - Yu Han
- Heart Center of Henan Provincial People's Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaopeng Hu
- Structural Heart Disease Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Li
- Structural Heart Disease Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Shi
- Structural Heart Disease Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangbin Pan
- Structural Heart Disease Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Ng LY, Al-Alawi K, Breatnach C, Nolke L, Redmond M, McCrossan B, Oslizlok P, Walsh KP, McGuinness J, Kenny D. Hybrid Subxiphoid Perventricular Approach as an Alternative Access in Neonates and Small Children Undergoing Complex Congenital Heart Interventions. Pediatr Cardiol 2021; 42:526-532. [PMID: 33263794 DOI: 10.1007/s00246-020-02510-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
The hybrid subxiphoid perventricular approach provides direct access through the heart and may alleviate the technical limitations of complex percutaneous interventions particularly in infants with low body weight. We present the outcomes from a tertiary cardiology center using this approach. We performed a retrospective review of all patients less than 15 kg who underwent a hybrid perventricular approach via a small subxiphoid incision. Medical records were reviewed to obtain clinical, demographic and outcome data. Seventeen patients underwent 18 hybrid perventricular procedures using a subxiphoid approach. Median age at time of procedure was 4.6 months (IQR = 1.6 to 18 months) and median weight was 6.2 kgs (IQR = 3.4 to 8.6 kgs). Six patients underwent hybrid pulmonary valve replacement (PVR), 5 patients underwent pulmonary outflow stenting, and 5 infants underwent hybrid ventricular septal defect (VSD) device closure. One patient with a single ventricle who did not tolerate a percutaneous approach underwent left pulmonary artery (LPA) stenting for severe LPA coarctation with subsequent right ventricular outflow tract (RVOT) stenting. One further patient underwent implantation of a larger diameter stent for pulmonary artery bifurcation stenosis. Procedure success rate was 89% with two of the VSD cases reverted to open surgical repair. There were no intra-procedural complications; however, one patient died within 72 h. Minor adverse events occurred in 2 patients including a wound infection in one patient with an immunodeficiency syndrome. Hybrid subxiphoid perventricular approach provides an excellent alternative access to the heart especially in low birth weight infants to prevent hemodynamic instability or in small children requiring large delivery sheaths.
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Affiliation(s)
- Li Yen Ng
- Children Health Ireland at Crumlin, Dublin, Ireland.
| | | | | | - Lars Nolke
- Children Health Ireland at Crumlin, Dublin, Ireland
| | - Mark Redmond
- Children Health Ireland at Crumlin, Dublin, Ireland
| | - Brian McCrossan
- Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
| | | | | | | | - Damien Kenny
- Children Health Ireland at Crumlin, Dublin, Ireland
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Xu N, Chen Q, Huang ST, Sun KP, Cao H. Sufentanil Reduces Emergence Delirium in Children Undergoing Transthoracic Device Closure of VSD After Sevoflurane-Based Cardiac Anesthesia. Braz J Cardiovasc Surg 2020; 35:660-665. [PMID: 33118730 PMCID: PMC7598960 DOI: 10.21470/1678-9741-2019-0334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective The aim of this study was to evaluate whether sufentanil can reduce emergence delirium in children undergoing transthoracic device closure of ventricular septal defect (VSD) after sevoflurane-based cardiac anesthesia. Methods From February 2019 to May 2019, 68 children who underwent transthoracic device closure of VSD at our center were retrospectively analyzed. All patients were divided into two groups: 36 patients in group S, who were given sufentanil and sevoflurane-based cardiac anesthesia, and 32 patients in group F, who were given fentanyl and sevoflurane-based cardiac anesthesia. The following clinical data were recorded: age, sex, body weight, operation time, and bispectral index (BIS). After the children were sent to the intensive care unit (ICU), pediatric anesthesia emergence delirium (PAED) and face, legs, activity, cry, consolability (FLACC) scale scores were also assessed. The incidence of adverse reactions, such as nausea, vomiting, drowsiness and dizziness, was recorded. Results There was no significant difference in age, sex, body weight, operation time or BIS value between the two groups. Extubation time (min), PEAD score and FLACC scale score in group S were significantly better than those in group F (P<0.05). No serious anesthesia or drug-related side effects occurred. Conclusions Sufentanil can be safely used in sevoflurane-based fast-track cardiac anesthesia for transthoracic device closure of VSD in children. Compared to fentanyl, sufentanil is more effective in reducing postoperative emergence delirium, with lower analgesia scores and greater comfort.
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Affiliation(s)
- Ning Xu
- Fujian Medical University Fujian Provincial Maternity and Children's Hospital Department of Cardiac Surgery Fuzhou P. R. China Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, P. R. China
| | - Qiang Chen
- Fujian Medical University Union Hospital Department of Cardiovascular Surgery Fuzhou P. R. China Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P. R. China
| | - Shu-Ting Huang
- Fujian Medical University Fujian Provincial Maternity and Children's Hospital Department of Cardiac Surgery Fuzhou P. R. China Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, P. R. China
| | - Kai-Peng Sun
- Fujian Medical University Fujian Provincial Maternity and Children's Hospital Department of Cardiac Surgery Fuzhou P. R. China Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, P. R. China
| | - Hua Cao
- Fujian Medical University Fujian Provincial Maternity and Children's Hospital Department of Cardiac Surgery Fuzhou P. R. China Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, P. R. China
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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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Hinton ZW, Meza JM, Habermann AC, Andersen ND, Daneshmand MA, Turek JW. Right Anterior Mini-Incision Approach to Anomalous Right Coronary Artery Repair. World J Pediatr Congenit Heart Surg 2020; 11:215-216. [DOI: 10.1177/2150135119892928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The right anterior mini-incision has emerged as an effective minimally invasive approach for adult aortic root and valve operations. However, adoption of minimally invasive techniques has been limited in congenital heart surgery. We report a case of anomalous aortic origin of the right coronary artery repair performed through this approach. Following successful right coronary artery unroofing, the patient had an uncomplicated postoperative hospitalization.
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Affiliation(s)
- Zoe W. Hinton
- Duke University School of Medicine, Durham, NC, USA
- Duke Congenital Heart Surgery Research & Training Laboratory, Duke University, Durham, NC, USA
| | - James M. Meza
- Duke Congenital Heart Surgery Research & Training Laboratory, Duke University, Durham, NC, USA
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Alyssa C. Habermann
- Duke University School of Medicine, Durham, NC, USA
- Duke Congenital Heart Surgery Research & Training Laboratory, Duke University, Durham, NC, USA
| | - Nicholas D. Andersen
- Duke University School of Medicine, Durham, NC, USA
- Duke Congenital Heart Surgery Research & Training Laboratory, Duke University, Durham, NC, USA
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Children’s Pediatric & Congenital Heart Center, Duke Children’s Hospital, Durham, NC, USA
| | - Mani A. Daneshmand
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, GA, USA
| | - Joseph W. Turek
- Duke University School of Medicine, Durham, NC, USA
- Duke Congenital Heart Surgery Research & Training Laboratory, Duke University, Durham, NC, USA
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
- Duke Children’s Pediatric & Congenital Heart Center, Duke Children’s Hospital, Durham, NC, USA
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14
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Stone M, Ing RJ. Transthoracic Ventricular Septal Defect Closure in Children: An Evolving Treatment Strategy as an Alternative to Open Surgical Repair. J Cardiothorac Vasc Anesth 2018; 33:1267-1268. [PMID: 30217586 DOI: 10.1053/j.jvca.2018.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Matthew Stone
- Department of Cardiothoracic Surgery, Children's Hospital Colorado, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO
| | - Richard J Ing
- Department of Anesthesiology, Children's Hospital Colorado, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO
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