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Treatment of isolated ventricular septal defects in children: a comparative analysis between minimally invasive transthoracic and percutaneously
Quansheng Xing, Qin WU.
Qingdao Women and Children's Hspital, Qingdao University, Qingdao, China.
Objective: Since the introduction of off-pump minimally invasive transthoracic device closure (MITDC) of isolated ventricular septal defect (VSD) in 2007, the management of isolated VSD has evolved. It has been proved that MITDC of isolated VSD is a safe and effective alternative to conventional surgical treatment. A comparative analysis of MITDC vs. the other conventional treatment, pecutaneously transcatheter device closure (PTDC), for isolated VSD is needed.
Methods: A total of 215 patients with isolated VSD were enrolled from March 2011 to March 2014. The patients were divided into off-pump MITDC group and PTDC 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, hospital stay time, cost of hospitalization and complications) were also compared between the two groups.
Results: The MITDC group was significantly younger (p < 0.01) and smaller in size (p < 0.001) than the PTDC group. In PTDC group, 72 cases were successfully closed, and 5 were converted to MITDC, 4 with successful closure, and 1 converted to surgical closure after failed MITDC. In MITDC group, 135 cases were successfully closed, and 3 were converted to surgical closure. There was no occurrence of main complications in both two groups during hospital stay and follow-up. There was no difference between two groups according to incidence of major complications, hospital stay, and cost of hospitalization, but the operating time, incidence of minor complications during hospitalization and fellow-up period were significantly shorter or lower in MITDC group than in PTDC group (table 1).
Conclusions: MITDC of isolated VSD is an effective method with fewer complications, shorter operating time, higher safety and a wider range of indications than PTDC. It can not only serve as a reasonable alternative treatment for PTDC, but also with a wider range of indications.
Table 1. Treatment characteristics and follow-up data of patients undergoing MITDC or PTDC of
isolated VSDs
| Characteristic | MITDC | PDTC | pValue |
| Number | 138 | 77 | |
| Age (months) | 12.3±8.5 (3-36) | 36.8±15.6 (26-78) | 0.001 |
| Weight (Kg) | 8.9±7.6 (4.5-15.6) | 19.6±11.3 (15-36) | 0.003 |
| Operating time (minutes) | 18.5±15.7 (5-45) | 85.6±53.8 (55-168) | 0.001 |
| Successful rate (%) | 135 (97.8) | 72 (93.5) | 0.121 |
| Hospital stay (days) | 6.5±3.7 (4-11) | 5.6±4.6 (4-9) | 0.663 |
| Cost of hospitalization (10,000 RMB) | 3.2±2.4 (2.6-5.9) | 3.23±2.79 (2.2-6.3) | 0.567 |
| Complications before discharge | |||
| Hydropericadium (%) | 6 (4.4) | 16 (22.2) | 0.000 |
| ECG | |||
| iRBBB or cRBBB (%) | 21 (9.30) | 23 (19.79) | 0.000 |
| iLBBB | 0 | 1 (1.4) | 0.170 |
| cAVB | 0 | 0 | |
| Echocardiography | |||
| Trace to mild TR (%) | 13 (9.6) | 23 (31.9) | 0.000 |
| Trace to mild AR (%) | 3 (2.2) | 9 (12.5) | 0.003 |
| Residual shunting | |||
| Trivial to small (%) | 11 (8.1) | 17 (23.6) | 0.002 |
| Moderate | 0 | 1 (1.4) | |
| Follow-up time (months) | 32.7±18.8 (18-54) | 33.5±15.9 (18-84) | 1.793 |
| Follow-up rate (%) | 130 (96.3) | 69 (95.8) | 0.948 |
| Complications during follow-up | |||
| ECG | |||
| iRBBB or cRBBB (%) | 15 (11.1) | 20 (27.8) | 0.002 |
| iLBBB | 1 (0.7) | 0 | 0.464 |
| cAVB | 0 | 0 | |
| Echocardiography | |||
| Trace to mild TR (%) | 12 (8.9) | 23 (31.9) | 0.000 |
| Trace to mild AR (%) | 1 (0.7) | 3 (4.2) | 0.088 |
| Residual shunting | |||
| Trivial to small (%) | 7 (5.2) | 11 (15.3) | 0.019 |
| Moderate | 0 | 0 |
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