Intraoperative Device Closure of Isolated Ventricular Septal Defects: Experience on 1,090 Cases

Abstract

Background: This study summarizes the clinical experience and 8-year follow-up results of the intraoperative device closure of ventricular septal defects (VSD).

Methods: From January 2009 to June 2017, 1,090 patients with isolated VSD were enrolled at our institute to participate in the study. The procedure involved a small lower sternal incision that was performed after full evaluation of VSD by transesophageal/transthoracic echocardiographic (TEE/TTE) guidance and the deployment of a domestically made occluder to close the VSD periventricularly and off cardiopulmonary bypass. Follow-up was in the first 3 months and then every 1 to 2 years with TTE, electrocardiography, and upon symptoms.

Results: In all, 1,033 patients were occluded successfully under this approach, and the remaining patients were converted to surgical repair. The size of the occluder deployed ranged from 6 to 14 mm and included 825 symmetric devices and 208 asymmetric devices. A total of 25 patients developed severe arrhythmias, including 11 cases of complete atrioventricular block and 14 cases of Mobitz type II atrioventricular block, during and after the procedure.

Conclusions: Minimally invasive transthoracic device closure of VSD with an asymmetric or symmetric domestically made device on a beating heart is a safe and feasible alternative to conventional surgical repair. More experience in multicenter and long-term follow-up is necessary to assess the actual feasibility and safety of this procedure.