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Long-term outcomes after conventional surgical repair versus perventricular device occlusion for doubly committed
ZhenMei Liao1, Hang Chen1, Li Lin1
1Heart Center of Fujian Province, Union Hospital, Fujian Medical University, Fuzhou, China.
Insights
Peventricular device occlusion offers comparable safety and efficacy to surgical repair for doubly committed subarterial ventricular septal defects. This less invasive approach reduces hospitalization and mechanical ventilation time.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Medical Device Technology
Background:
- Doubly committed subarterial ventricular septal defect (DSVSD) requires effective treatment.
- Previous studies comparing surgical repair and device occlusion had baseline characteristic limitations.
Purpose of the Study:
- To compare long-term outcomes of perventricular device occlusion versus surgical repair for DSVSD.
- To address limitations of prior studies using propensity score matching.
Main Methods:
- Retrospective review of pediatric patients (<18 years) with isolated DSVSD from 2011-2017.
- Propensity score matching to create comparable cohorts for device occlusion and surgical repair groups.
- Analysis of cumulative adverse events, hospitalization duration, and mechanical ventilation time.
Main Results:
- Matched cohorts: 164 surgical repair, 91 device occlusion.
- No significant difference in cumulative adverse events (7.9% vs 5.5%).
- Surgical repair group had longer hospitalization and mechanical ventilation (P<0.05).
Conclusions:
- Peventricular device occlusion is a safe and effective alternative to surgical repair for selected DSVSD patients.
- Device occlusion demonstrates reduced invasiveness, shorter hospital stays, and less need for mechanical ventilation.
- No high-grade valvular regurgitation or atrioventricular block observed in either group.
Objectives:
This study aimed to investigate the long-term outcomes of perventricular device occlusion and surgical repair for doubly committed subarterial ventricular septal defect using propensity score matched analysis because previous comparative studies were limited by differences in the baseline characteristics.
Methods:
We reviewed inpatients with isolated doubly committed subarterial ventricular septal defect aged <18 years who underwent surgical repair or device occlusion between January 2011 and December 2017. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics.
Results:
A total of 336 patients underwent surgical repair; 99 underwent device occlusion. After matching, the repair group included 164 patients, whereas the device group had 91 patients. There were no significant differences in the baseline characteristics. The median follow-up periods were 46 and 58 months for the device and repair groups, respectively. No significant difference was noted in the rates of cumulative adverse events in the 2 groups (7.9% vs 5.5%; P = 0.61). The repair group required longer periods of hospitalization (P = 0.002) and mechanical ventilation (P = 0.016). No grade 3 or higher valvular regurgitation or high-degree atrioventricular block events were observed. All patients were in sinus rhythm at the last follow-up examination.
Conclusions:
In selected patients with doubly committed subarterial ventricular septal defect, compared with conventional repair, perventricular device occlusion has comparable efficacy and safety, less invasiveness in terms of time in the hospital and on mechanical ventilation and avoidance of cardiopulmonary bypass.
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