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Treatment of Isolated Ventricular Septal Defect: Off-pump Transthoracic Device Occlusion versus Surgical Closure with Cardiopulmonary bBypass
Qin Wu, Quansheng Xing.
Children's Hospital of Qingdao Univercity, Qingdao, China.

Background: Given the increasing popularity of off-pump transthoracic device closure (OTDC) of ventricular septal defect (VSD) since 2007, a comparative analysis of the different treatments (surgical vs. transthoracic device closure) for VSDs is needed.
Methods: A total of 436 patients with VSDs were randomly divided into two groups: 248 patients treated with OTDC (device group) and 188 patients underwent traditional surgical repair (surgical group). Patients were followed up with the same standard protocol. Clinical, ECG, and echocardiographic data before and after operation were analyzed. Several characteristics (e.g. operating time, complications, blood transfusions, hospital stay time, cost of hospitalization and complications after operations) were also compared between the two groups.
Results: There were no differences between the two groups according to preoperative baseline characteristics (table 1). There was no occurrence of main complications in both two groups during hospital stay and follow-up. Minor complications (such as incomplete right bundle branch block, trace to mild tricuspid regurgitation, hydropericardium, and so on) occurred in both groups. The differences between two groups were shown in table 2. The cardiac function was NYHA class I in all subjects.
Conclusions: OTDC of VSD is an effective method which can save lots of blood products and extracorporeal circulation medical supplies. It can serve as a reasonable alternative treatment with fewer complications and good cosmetic effect for traditional cardiac surgery.
Table 1. Preoperative baseline characteristics of patients undergoing transthoracic device or surgical closure of isolated VSD
CharacteristicTransthoracic device closureSurgical closurepValue
Number248188
Gender
Male13792
Female11196
Age (months)21.5±18.7 (3-180)18.6±14.3 (2-90)0.12
Body weight (kilogram)14.7±10.9 (4.5-48)12.5±9.6 (4-29)0.31
Chest X-ray
Cardiothoracic ratio0.55±0.09 (0.47-0.61)0.56±0.11 (0.49-0.63)0.28
ECG
iRBBB1811
iLBBB10
cRBBB38
Echocardiography
VSD size, mm5.2±2.9 (3-10)5.8±3.7 (3-12)0.09
VSD location
Perimembranous235154
Subarterial523
Muscular811
Trace to mild TR2326
AR37
LVEF (%)61.3±5.8 (58-71)58.3±6.9 (55-68)0.18
LV-RV grandient (mmHg)55.3±12.8 (41-69)48.2±21.4 (39-56)0.04

Table 2. Procedural characteristics and follow-up data of patients undergoing transthoracic device or surgical closure of isolated VSD
CharacteristicTransthoracic device closureSurgical closurepValue
Number248188
Operating time (minutes)30.5±19.795.6±53.80.001
Mechanical ventilation time (hours)0.8±0.63.2±2.80.02
ICU stay (hours)18.6±9.524.8±17.20.012
Blood transfusion (%)12 (4.84)188 (100)<0.001
Complications before discharge
Hydropericadium (%)12 (4.84)17 (9.04)0.03
Incision infection (%)4 (1.61)7 (3.72)0.02
ECG
iRBBB or cRBBB (%)31 (12.5)27 (14.4)0.25
iLBBB10
cAVB00
Echocardiography
Trace to mild TR (%)36 (14.5)35 (18.6)0.36
AR (%)2 (0.8)8 (4.3)0.02
Residual shunting
Trivial to small (%)27 (10.9)31 (16.5)0.17
Moderate01
Hemolysis00
Hematuria00
Thrombembolism00
Cost of hospitalization (1,000 RMB)25.97±10.2429.56±15.380.52
Follow-up time (months)36.5±18.736.1±19.50.88
Follow-up rate (%)236 (95.2)178 (94.7)0.67
Complications during follow-up
ECG
iRBBB or cRBBB (%)35 (14.8)33 (18.5)0.61
iLBBB10
cAVB00
Echocardiography
Trace to mild TR (%)22 (9.3)25 (14.0)0.09
AR (%)1 (0.4)6 (3.4)<0.001
Residual shunting
Trivial to small (%)11 (4.7)27 (15.2)0.02
Moderate00

iRBBB, incomplete right bundle branch block; iLBBB, incomplete left bundle branch block; cRBBB, complete right bundle branch block; cAVB, complete atrioventricular block; TR, tricuspid regurgitation; AR, aortic regurgitation; LV, left ventricle; RV, right ventricle; LVEF, left ventricle ejection fraction.


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