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Transfemoral and perventricular device occlusions and surgical repair for doubly committed subarterial ventricular

Chen Zhao Yang1, Cao Hua2, Ma Yuan Ji3

  • 1Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China.

The Annals of Thoracic Surgery
|April 2, 2015
PubMed

Insights

Perventricular device occlusion is a preferred, successful alternative to transfemoral occlusion for doubly committed subarterial ventricular septal defect (dcVSD). Surgical repair remains effective but involves longer recovery times compared to device occlusions.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Pediatric Cardiology

Background:

  • Doubly committed subarterial ventricular septal defect (dcVSD) management involves surgical repair or less invasive device occlusions via transfemoral or perventricular approaches.
  • Comparative data on the efficacy and safety of these three dcVSD treatment modalities are limited.

Purpose of the Study:

  • To compare the procedural success rates, clinical outcomes, and adverse events of transfemoral device occlusion, perventricular device occlusion, and conventional surgical repair for isolated dcVSD.

Main Methods:

  • Retrospective review of inpatient data for patients with isolated dcVSD undergoing transfemoral or perventricular device occlusion or surgical repair between January 2009 and June 2013.
  • Comparison of procedural success, hospitalization duration, intensive care unit (ICU) stay, operating room time, mechanical ventilation duration, transfusion rates, and adverse event profiles.

Main Results:

  • Procedural success rates were 66% for transfemoral, 94.9% for perventricular, and 97.6% for surgical repair, with transfemoral occlusion being significantly less successful (p < 0.001).
  • The surgical repair group experienced longer hospitalizations, ICU stays, operating times, and ventilation durations, along with higher transfusion rates (all p < 0.001).
  • Adverse event rates were comparable across all three groups (p = 0.569), with no significant valvular regurgitation or atrioventricular block observed.

Conclusions:

  • Device occlusion, particularly the perventricular approach, is a viable and effective alternative to surgical repair for selected patients with dcVSD, offering comparable safety.
  • Perventricular occlusion demonstrates a superior success rate compared to the transfemoral approach for dcVSD closure.
Abstract

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