Transthoracic closure of atrial septal defect and ventricular septal defect without cardiopulmonary bypass

Abstract

ABSTRACT. The minimally invasive surgical transthoracic occlusion of an atrial septal defect (ASD) or a ventricular septal defect (VSD) is an increasingly widespread alternative treatment for congenital heart disease. The aim of this study is to summarize our clinical experience with minimally invasive surgical transthoracic occlusion of ASD and VSD without cardiopulmonary bypass (CPB). Between April 2011 and October 2012, 27 patients with ASD and 95 patients with VSD (78 men and 44 women) were considered for minimally invasive surgical transthoracic occlusion without CPB. A small infrasternal incision (2.0-4.0 cm) was made under general anesthesia, under transesophageal echocardiography (TEE) guidance; the ASD and VSD were closed by using an appropriate occluder; and TEE was performed simultaneously to demonstrate the position of the device, any residual shunting, or encroachment on the atrioventricular valve, coronary sinus, or aortic valve. Successful transthoracic occlusion was performed in all 122 3761 ©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 14 (2): 3760-3766 (2015) Minimally invasive surgical transthoracic occlusion patients without complications. No complications such as thirddegree atrioventricular block and residual shunting occurred after the procedures. The ventilation time was 2.2 ± 1.2 h, and the average length of hospital stay was 4.7 ± 1.7 days. All patients received aspirin at 3 mg·kg -1 ·day -1 (maximum 100 mg/day) 24 h after the procedure. Minimally invasive surgical transthoracic occlusion without CPB is a new treatment that has many advantages such as causing little trauma, promoting quick recovery, having less complications, and avoiding radiation damage. However, the appropriate selection of patients is still key to improving the success rate of the operation.

RETRACTED ARTICLE: The effect of early oral stimulation with breast milk on the feeding behavior of infants after congenital cardiac surgery

“…There are more postoperative complications associated with pediatric cardiac surgery than with conventional pediatric general surgery. In addition to cardiac function-related complications, systemic complications, such as abnormal liver and kidney function and impaired gastrointestinal function, often occur in the postoperative recovery stage [7,8]. The main reason is due to the impact of cardiopulmonary bypass and intraoperative hypothermia on various organ functions.…”

Effects of transthoracic device closure on ventricular septal defects and reasons for conversion to open-heart surgery: A meta-analysis

“…Among all the selected articles, 146 trials were conducted primarily in China 4–6,12,25–34,36–53,55–59,61,63,65–160,162,167,168,171–175,180,185,186 , 3 articles were conducted in other Asian countries (one each in India, South Korea and Turkey) 166,169,184 , 10 studies were conducted in the United States 11,62,64,163,170,176,178,179,181,182 , 5 studies were performed in European countries (one each in Austria, France, Germany, Poland, Russian Federation) 35,54,161,165,183 , 2 articles were conducted in South American countries (1 Brazil and 1 Chile) 164,177 , and 1 case-control study was performed in Australia 60 . A total of 108 articles were written in Chinese 5,12,26–29,31,32,36–43,46,70–132,134–159,174,175 , whereas 58 articles were written in English 4,6,11,25,30,33–35,44,45,47–69,133,160–163,165–173,176–186 , and the remaining article was written in Portuguese 164 .…”

“…Since then, many articles have described the use of TTDC with the Amplatzer occluder in VSD patients 52,57,64,181 . More recently, this technology has been widely applied throughout China 4–6,12,25–34,36–53,55–59,61,63,65–160,162,167,168,171–175,180,185,186 . Through this systematic review, we have attempted to compare the outcomes of TTDC versus COHS.…”

Evaluation of analgesic and sedative effects of remifentanil‐based fast‐track anesthesia in children undergoing transthoracic device closure of ventricular septal defects

“…In recent years, transthoracic device closure of VSDs without extracorporeal circulation, which is another possible treatment, has been widely used and reported in China. Transthoracic device closure of VSDs has the advantages of a small incision, rapid recovery, fewer complications, and avoidance of radiation exposure compared with surgical repair and percutaneous device closure 3,4 . Our center has carried out the application of remifentanil‐based fast‐track anesthesia in children undergoing transthoracic device closure of VSDs, which is conducive to early extubation, and reduced anesthesia time and length of intensive care unit (ICU) and hospital stay 5,6 .…”

“…and avoidance of radiation exposure compared with surgical repair and percutaneous device closure. 3,4 Our center has carried out the application of remifentanil-based fast-track anesthesia in children undergoing transthoracic device closure of VSDs, which is conducive to early extubation, and reduced anesthesia time and length of intensive care unit (ICU) and hospital stay. 5,6 However, there are few reports about the effects of postoperative analgesia and sedatives in these patients.…”