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Unplanned Surgery After Transcatheter Closure of Ventricular Septal Defect in Children: Causes and Risk Factors
Penghui Yang1,2,3,4, Zhijun Wu5, Zhiyuan Liu1,2,3,4
1Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.
Insights
Unplanned surgery after transcatheter closure of ventricular septal defect (VSD) in children is often caused by aortic regurgitation. Risk factors include aortic valve prolapse, intracristal VSD, and larger occluder size.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Transcatheter closure is a common treatment for ventricular septal defects (VSD) in children.
- Understanding complications is crucial for improving patient outcomes.
Purpose of the Study:
- To identify the causes and risk factors for unplanned surgery following transcatheter VSD closure in pediatric patients.
- To inform clinical decision-making and risk stratification.
Main Methods:
- Retrospective review of 773 pediatric patients undergoing transcatheter VSD closure (2013-2018).
- Univariate and multivariate logistic regression analyses were performed to determine risk factors for unplanned surgery.
Main Results:
- 3.1% of patients (24/773) required unplanned surgery.
- The primary cause was new or worsening aortic regurgitation (58.3%).
- Significant risk factors identified included primary aortic valve prolapse, intracristal VSD, eccentric occluder, larger occluder size, and pulmonary artery systolic pressure ≥45 mmHg.
Conclusions:
- New-onset or worsening aortic regurgitation is the leading indication for unplanned surgery post-VSD transcatheter closure.
- Specific patient and procedural factors predict the need for subsequent surgery, aiding in risk assessment.
Abstract:
Objectives: To evaluate the causes and risk factors of unplanned surgery after transcatheter closure of ventricular septal defect (VSD) in children. Methods: A total of 773 patients with VSD who had the devices transcatheter released between January 2013 and December 2018 in our institution were retrospectively reviewed. Univariate and multivariate analyses were used to identify the risk factors for unplanned surgery. Results: Twenty four patients (3.1%) underwent unplanned surgery after transcatheter closure of VSD. The most common cause for unplanned surgery was new-onset or worsening aortic regurgitation (14/24; 58.3%), followed by occluder migration (4/24; 16.7%), complete atrioventricular block (2/24; 8.3%), severe hemolysis (2/24; 8.3%), residual shunt (1/24; 4.2%), and occluder edge near the tricuspid valve chordae (1/24; 4.2%). Logistic regression analysis revealed that primary aortic valve prolapse (OR: 5.507, 95%CI: 1.673-18.123, P = 0.005); intracristal VSD (OR: 8.731, 95%CI: 2.274-33.527, P = 0.002); eccentric occluder (OR: 4.191, 95%CI: 1.233-14.246, P = 0.022); larger occluder size (OR: 1.645, 95%CI: 1.331-2.033, P < 0.001); and pulmonary artery systolic pressure ≥45 mmHg (OR: 4.003, 95%CI: 1.073-14.941, P = 0.039) were risk factors for unplanned surgery. Conclusions: New-onset or worsening aortic regurgitation was the primary cause for unplanned surgery after transcatheter closure of VSD in children. Primary aortic valve prolapse, intracristal VSD, eccentric occluder, larger occluder size, pulmonary artery systolic pressure ≥45 mmHg could increase the risk of unplanned surgery.
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