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Minimally invasive transthoracic device closure of isolated ventricular septal defects under transesophageal echocardiography without cardiopulmonary bypass: a 7-year multicenter experience
Quansheng Xing1, Qin Wu1, Ping Wen2, Xuming Mo3, Zewei Zhang4.
1Children’s Heart Center, Qingdao Women and Children’s Hospital, Qingdao University, Qingdao, China, 2Children’s Heart Center, Dalian Children’s Hospital, Dalian Medical University, Dalian, China, 3Cardiothoracic Surgery Department, Nanjing Children’s Hospital, Nanjing Medical University, Nanjing, China, 4Cardiothoracic Surgery Department, The Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China.

OBJECTIVE: Ventricular septal defect (VSD) is the most common congenital heart defect. Minimally invasive transthoracic device closure (MITDC) of VSDs under transesophageal echocardiography (TEE) guidance without cardiopulmonary bypass was initialy performed in China in 2007 and has increasingly been performed in China and out of China. The aim of the study was to analyze the safety, efficacy, and long-term follow-up data associated with this technique.
METHODS: From March 2007 to March 2014, 1393 cases with VSD size from 3 to 12 cm (5.68±4.57cm) underwent this procedure at 4 children’s heart centers in China. All the procedures were performed in the operating room. A 3-5 cm inferior sternotomy or the left third intercostals incision was made. Under TEE guidance, through the chosen right ventricle (RV) free wall puncturing point, the delivery system with occlusion device of appropriate size was introduced into RV cavity, defect and then left ventricular (LV) cavity. Then, the LV disc, waist and the RV disc were deployed in LV, septum and RV respectively. After complete TEE assessing for absence of complications, the device was released. Patients were followed up with a standard protocol. Cardiac function in each follow-up cases and adverse events were recorded and evaluated.
RESULTS: The procedure was successful in 1304 cases (93.6%), and was converted to conventional surgical repair in 89 patients (6.4%). The mean device implanting time (puncture to release) was 18.5±11.9 min (3 to 48 min). The mean device size implanted was 6.52±4.16 mm (4 to 14 mm). 1239 patients (95.0%) were followed up. During a mean 45.3±23.6 months (8 to 92 months) follow-up period, no mortality occurred. A total of three major adverse events (0.2%) were reported, all of them were complete atrioventricular block. Meanwhile, 104 minor adverse events were detected during the entire follow-up period. The data of EF, FS and CI on echocardiography were normal in all the follow-up cases.
CONCLUSIONS: Data from the current study suggest that MITDC of VSDs appeared to be excellent with encouraging long-term outcomes. This technique not only provides a third alternative to open heart surgery and transcatheter closure but also shows more advantages.

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