Transfemoral Device Occlusion and Minimally Invasive Surgical Repair for Doubly Committed Subarterial Ventricular Septal Defects

Abstract

Transfemoral device occlusion and minimally invasive surgical repair are performed for doubly committed subarterial ventricular septal defect (dcVSD) to reduce the invasiveness of the conventional surgical repair through a median sternotomy. However, few studies have compared them in terms of effectiveness and cost. Inpatients with isolated dcVSD who had undergone transfemoral device occlusion or minimally invasive surgical repair from January 2011 to June 2014 were reviewed for a comparative investigation between the two procedures. Procedure success was achieved in 36 transfemoral (75 %) and in 36 surgical (100 %) procedures (p = 0.001). Transfemoral patients were older, with a VSD size similar to that of surgical patients (14.5 ± 11.7 vs 4.4 ± 2.9 years, p < 0.001; 4.5 ± 1.5 vs 4.4 ± 1.3 mm, p = 0.577, respectively). No significant difference was observed in complication rates between the two treatment groups (p = 1). No large residual shunt was observed. Small residual shunt was noted in two transfemoral patients and four surgical patients (p = 0.674). All these small residual shunts closed spontaneously during follow-up. The surgical repair costs 26 % less than the device occlusion (Yuan 22063.2 ± 343.9 vs Yuan 29970.1 ± 1335.2, p < 0.001), where most of the cost was attributed to the occluder in the amount of Yuan 19,500. Compared with device occlusion, minimally invasive surgical repair can provide superior efficacy and comparable complication rates. In addition, it is 26 % cheaper than device occlusion. In low-income countries where healthcare resources are limited, medical resources must be judiciously allocated to the treatment that allows for effective treatment of the largest number of patients.

A study on eccentric occluder via ultra minimal incision of doubly committed subarterial ventricular septal defects

“…The application of eccentric occluder has made minimally invasive interventional therapy of DCS-VSD widely available. [3][4][5] TEE-guided transthoracic occlusion, without cardiopulmonary bypass cardiopulmonary bypass, and no radiation, is an excellent surgical stratege.…”

“…In recent years, transoesophagel echocardiography (TEE) guided surgical occlusion of ventricular septal defect has made great progress. The application of eccentric occluder has made minimally invasive interventional therapy of DCS‐VSD widely available 3–5 . TEE‐guided transthoracic occlusion, without cardiopulmonary bypass cardiopulmonary bypass, and no radiation, is an excellent surgical stratege.…”

“…The application of eccentric occluder has made minimally invasive interventional therapy of DCS-VSD widely available. [3][4][5] TEE-guided transthoracic occlusion, without cardiopulmonary bypass cardiopulmonary bypass, and no radiation, is an excellent surgical stratege.At present, the surgical approaches for DCS-VSD occlusion surgery mainly include sternum incision, intercostal incision on the left side and underarm incision. 1,3,6,7 This study reports a comparison of the Institutional Review Board: This study is a retrospective study of clinical surgery and does not require IRB approval.…”

Minimally access via left anterior mini-thoracotomy for repair of adult subarterial ventricular septal defects

“…Researchers have explored transcatheter interventional occlusion and periventricular occlusion to determine whether these approaches can be feasibly applied in the treatment of subarterial VSDs [3, 11]. However, due to low success rate and increased incidence of postoperative complications, including residual shunt, arrhythmias, hemolysis, thromboemboli, aortic valve regurgitation, and translocation of closure device, the short- and long-term outcomes of these approaches are unfavorable [11–18]. Liu et al [14] reported intraoperative device closure of subarterial VSDs in 62 cases.…”

Outcomes of closure of doubly committed subarterial ventricular septal defects in adults

“…The ventricular septal defect was closed with a pericardial patch. 14,15 An aortotomy was made when aortic valve exploration was required. Aortic valvuloplasty or aortic valve replacement was performed when more than moderate aortic insufficiency was confirmed or at the discretion of operator.…”