Doubly committed ventricular septal defect closure using eccentric occluder via ultraminimal incision

Area of Science:

• Pediatric Cardiology
• Minimally Invasive Cardiac Surgery
• Echocardiography

Background:

• Doubly committed ventricular septal defects (DCVSDs) are a subset of congenital heart defects.
• Traditional surgical repair often involves sternotomy, leading to longer recovery times.
• Minimally invasive techniques are increasingly explored for pediatric cardiac interventions.

Purpose of the Study:

• To evaluate the safety, feasibility, and availability of DCVSD closure using an ultraminimal intercostal incision.
• To assess the efficacy of transoesophageal echocardiography (TEE) guidance in this procedure.
• To determine the outcomes of this novel approach in pediatric patients.

Main Methods:

• 35 children with DCVSDs (≤5 mm) underwent closure using a left parasternal ultraminimal intercostal incision (≤1 cm).
• A pericardium hanging technique and a short delivery sheath with an eccentric occluder were employed.
• Transoesophageal echocardiography guided the entire procedure, with follow-up assessments.

Main Results:

• 100% success rate in complete DCVSD closure among all 35 patients.
• Average operation duration was 45.42 minutes, with an average hospital stay of 8 days.
• No complications were observed during or after the procedure, and pre-existing mild aortic regurgitation resolved in one patient.

Conclusions:

• Ultraminimal intercostal incision DCVSD closure guided by TEE is a safe, feasible, and effective option for children.
• This minimally invasive approach offers excellent outcomes and is recommended for clinical use.
• The eccentric occluder device facilitates successful closure through a small incision.