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Perventricular device closure of ventricular septal defects: results in patients less than 1 year of age
Alexander Omelchenko1, Yuriy Gorbatykh1, Alexey Voitov2
1Division of Congenital Heart Surgery, State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
Insights
Perventricular device closure is a safe and effective minimally invasive treatment for infants with ventricular septal defects. This approach offers a faster recovery and better cosmetic outcomes than traditional surgery.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Medical Devices
Background:
- Ventricular septal defects (VSDs) are common congenital heart abnormalities.
- Conventional surgical repair often involves cardiopulmonary bypass (CBP), posing risks for infants.
- Minimally invasive techniques are sought to improve outcomes in pediatric cardiac surgery.
Purpose of the Study:
- To evaluate the safety and efficacy of perventricular device closure for VSDs in patients under 1 year of age.
- To compare this technique with conventional surgical repair.
- To assess outcomes including procedural success, complications, and recovery time.
Main Methods:
- A cohort of 51 infants (<1 year old) with VSDs underwent perventricular device closure.
- The procedure utilized transesophageal echocardiography (TOE) guidance without CBP.
- VSD occlusion devices were inserted via a small sternal incision.
Main Results:
- A high procedural success rate of 96.1% was achieved.
- Patients experienced short intensive care unit (ICU) stays (16.5 ± 9.4 hours) and ventilation times (3.2 ± 3.5 hours).
- No major early postoperative complications, including atrioventricular blocks or significant residual shunts, were observed.
Conclusions:
- Perventricular device closure is a safe and highly effective option for VSDs in infants.
- This minimally invasive approach offers advantages over conventional surgery, including faster rehabilitation and superior cosmetic results.
- Long-term follow-up showed no residual shunts, conduction disturbances, or valve complications.
Objectives:
To present and share our experience in perventricular device closure of ventricular septal defects in patients less than 1 year old.
Methods:
From 2012-2014, 51 patients less than 1 year old with ventricular septal defects were operated on with minimally invasive transthoracic device closure under the guidance of transoesophageal echocardiography (TOE) without cardiopulmonary bypass (CBP). The median age at operation was 8.0 ± 2.5 months and the mean body weight was 7.9 ± 3.4 kg; 7.3% (5) of patients had a weight less than 5 kg. The Qp/Qs ratio was 1.9 ± 0.4. The ventricular septal defect size ranged from 3 to 9 mm; the mean diameter was 5.7 ± 1.6 mm; 27.4% (14) of defects were subaortic, 66.7% (34) perimembranous and 5.9% (3) were muscular. For defect closure, we used a ventricular septal defect occlusion device (Lepu Medical Technology Co., Ltd, Beijing, China) through a 3-cm skin incision in the lower third of the sternum.
Results:
The procedural success rate was 96.1% and there were 2 patients who were converted to open-heart surgery (3.9%) during procedures. The operation time 'skin to skin' was 55.9 ± 41.0 (40) min; 48.8% of cases were less than 40 min. Intensive care unit stay was 16.5 ± 9.4 (18) h; ventilation time was 3.2 ± 3.5 (2) h; all patients did not require inotropic support, blood transfusion and analgesia. Of the total, 7.8% (4) of patients had residual shunt of not more than 1 mm; there were no atrioventricular blocks, rhythm disturbances or other types of major complications in the early postoperative period. Length of hospital stay was 5.6 ± 3.2 days. The mean follow-up was 18.7 ± 10.1. Residual shunts, conduction disturbances or valve complications were not observed in any patients.
Conclusions:
Perventricular device closure of ventricular septal defects showed safety and high efficiency in patients less than 1 year of age, compared with conventional surgical repair with cardiopulmonary bypass, and provided a short period of rehabilitation and excellent cosmetic result.
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