Off-pump occlusion of trans-thoracic minimal invasive surgery (OPOTTMIS) on simple congenital heart diseases (ASD, VSD and PDA) attached consecutive 210 cases report: a single institute experience

Abstract

Objective: This paper intends to report our experiences by using an operation of off-pump occlusion of trans-thoracic minimal invasive surgery (OPOTTMIS) on the treatment of consecutive 210 patients with simple congenital heart diseases (CHD) including atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA).

Methods: The retrospective clinical data of OPOTTMIS in our institute were collected and compared to other therapeutic measures adopted in the relevant literatures. After operation, all the patients received electrocardiography (ECG) and echocardiography (echo) once a month within the initial 3 months, and no less than once every 3 ~ 6 months later.

Results: The successful rate of the performed OPOTTMIS operation was 99.5%, the mortality and complication incidence within 72 hours were 0.5% and 4.8%, respectively. There were no major complications during peri-operation such as cardiac rupture, infective endocarditis, strokes, haemolysis and thrombosis. The post-operation follow-up outcomes by ECG and echo checks of 3 months to 5 years showed that there were no III° AVB, no obvious Occluder migration and device broken and no moderate cardiac valve regurgitation, except 1 VSD and 1 PDA with mild residual shunts, and 2 PDA with heart expansion after operation. However, all the patients' heart functions were in class I~II according to NYH standard.

Conclusion: The OPOTTMIS is a safe, less complex, feasible and effective choice to selected simple CHD patients with some good advantages and favorable short-term efficacies.

Figure 1

Delivery systems and self-made devices used for OPOTTMIS. Outer sheath; Inner sheath; Guiding probe; Delivery rod; Retrieval wire.

Figure 2

ASD, VSD and PDA Occluders used in the OPOTTMIS. (Made in Shanghai shape memory alloy material Ltd. Co., CN, No.: 20043770007). A: ASD Occluder; B: VSD Occluder; C: PDA Occluder. The Occluders are made from Nitinol materials.

Figure 3

Procedures of OPOTTMIS. A: Through right atrium wall the outer sheath and guide probe across ASD; B: The inner sheath and the implanted and released Occluder with safe wirestraddled on the edges of ASD; C: Through the right ventricular wall the implanted and released Occluder straddled on the edges of VSD; D: Through the main pulmonary wall the implanted and released Occluder straddled on the edges of PDA; Device also referred as Occluder; Safe wire (gross silk suture) also referred as retrieval wire.

Figure 4

OPOTTMIS outcomes of pre-and post-operation with TEE surveillance. TEE images showing the abnormal blood stream disappeared post-OPOTTMIS.

Figure 5

Incisions comparison of OPOTTMIS and traditional open surgery (TOS). A: ASD; B: VSD; C: PDA; D: TOS.