Three centers experience with device closure of congenital Gerbode-type perimembranous ventricular septal defects

MIOS-MFO, a multicenter international observational study of the Lifetech KONAR-MF ventricular septal defect occluder in treating perimembranous ventricular septal defects

INTRODUCTION AND OBJECTIVES

The Lifetech KONAR-MF ventricular septal defect occluder (MFO) is increasingly used for transcatheter perimembranous ventricular septal defect (pmVSD) closure. We aim to collect real-world data on patient outcomes and MFO performance in pmVSD cases.

METHODS

This was a nonrandomized, retrospective, multicenter, postmarketing clinical follow-up study of pmVSD patients implanted with the MFO device between 2018 and 2023. The primary endpoint was 6-month composite clinical success, defined as technical success (successful implantation and device retention at the end of the procedure), closure success (trivial or no residual shunt), absence of serious adverse events at 30 days, and no device removal or reintervention. Secondary endpoints consisted of technical success, procedural success (technical success and less than moderate residual shunt), closure success (clinically insignificant or absent residual shunt), and safety.

RESULTS

Our cohort comprised 333 patients (51.4% male, 10.2% adults), with a median age of 4.6 [IQR, 2-10] years and a median weight of 17 [IQR, 11-32] kg. Baseline defect characteristics consisted of a left ventricular defect diameter of 8 [IQR, 7-10] mm, with 13.8% of patients having aortic valve regurgitation, 9.9% having an indirect Gerbode shunt, 10.5% having mild aortic valve prolapse, and 32.2% having subaortic rim deficiency. Closure via a retrograde approach was performed in 183 patients (55%). Technical success at procedure completion was 97.6%, and procedural success was 94.6%. Closure success at 6 months was 97.1%, while composite clinical success was 90.1%. Freedom from serious adverse events was 95.2% at 30 days. Freedom from device-related events was 96.8% at 6 months and 93.8% at 24 months. Risk factors for 6-month composite clinical failure were aortic valve prolapse (OR, 4.85; 95%CI, 2.07-11.39) and right ventricular defect diameter (OR, 1.41; 95%CI, 1.01-1.98).

CONCLUSIONS

Transcatheter closure of pmVSD with the MFO device demonstrated feasibility, effectiveness, and safety in real-world settings.

Management of Pediatric Congenital Heart Disease

We are pleased to present a Special Issue dedicated to pediatric cardiology [...].

Congenital Gerbode Defect: A Left Ventricular to Right Atrial Shunt-State-of-the-Art Review of Its General Data, Diagnostic Modalities, and Treatment Strategies

The congenital Gerbode defect is defined as an abnormal communication between the left ventricle and the right atrium. This review aimed to summarize existing evidence, shed light on the clinical implications, and identify knowledge gaps. The systematic literature search was conducted in the PubMed and Google Scholar medical databases using specifically selected keywords. The inclusion of each publication was assessed according to predefined eligibility criteria based on the PICOM (Population, Phenomenon of Interest, Context, Methodology) schema. Titles and abstracts were screened independently by two authors. Available full-text versions of included publications were reviewed and relevant information was extracted. A total of 78 reports were included. The compilation of all congenital Gerbode defect cases described in the literature revealed a variety of clinical presentations comprising dyspnea, palpitations, growth retardation, and asymptomatology. A suitable multimodal diagnostic approach for newborns consists of auscultation, TTE, and optionally TEE and MRI. Because of its rarity, diversity of findings, unknown pathophysiology, and similarity to more common cardiac diseases, the diagnostic challenge remains significant. To prevent untreated long-term sequelae, early individualized treatment is recommended. Surgical defect closure is preferred to device closure for evidence reasons, although major developments are currently taking place. In conclusion, the congenital Gerbode defect provides a diagnostic challenge for pediatricians to allow early diagnosis and intervention in order to improve patients' quality of life.

Procedural outcomes of percutaneous closure of perimembranous and other ventricular septal defects using Konar-MF occluder and short-term follow-up

Introduction

The study aims to assess the procedural outcomes and follow-up after transcatheter closure of ventricular septal defects (VSDs) in children utilizing the Konar-MF™ occluder (Lifetech Scientific, Shenzhen, PRC) device.

Materials and Methods

Clinical features, demographic characteristics, and follow-up findings of children undergoing percutaneous VSD device closure were retrospectively analyzed from the medical records.

Results

Fifty-seven patients underwent VSD closure using the Konar-MF occluder between January 2019 and April 2023. Median age and body weight of patients were 36 (5-216) months and 12.5 (3.8-42) kg, respectively. The mean size of the defect on the left ventricular side was 6.5 ± 2.4 mm on echocardiography; the mean pulmonary artery pressure was 19.1 ± 9.7 mmHg. Three patients with severe pulmonary hypertension had successful device closure. The most used device size was 8 mm × 6 mm. The initially chosen device was upsized in 4 (7.01%) patients and downsized in 1 (1.7%) patient. Forty-five patients (78.9%) had device closure through the retrograde route. The procedure was successful in 53 (93.0%) patients. Immediate shunt occlusion was achieved in 86.8% of patients. Major complications, namely, embolization (1) and moderate aortic regurgitation (1) in two patients were successfully managed by surgery. One patient with severe tricuspid regurgitation has been on close follow-up. There was no mortality. Late complications such as valve regurgitation or rhythm disturbance were not identified on a median follow-up of 6 (1.5-47) months.

Conclusion

Transcatheter VSD closure using a Konar-MF occluder device is safe and effective, even in smaller children. The ability to deliver both anterogradely and retrogradely is a unique advantage.

Transcatheter Closure of Perimembranous Ventricular Septal Defects Including Multifenestrated and Gerbode-Type Defects Using the Lifetech Konar Device

(1) Transcatheter closure of perimembranous ventricular septal defects (PmVSD) is becoming more attractive and effective with the development of new occluders. The aim of this study was to report a single-center experience in PmVSD closure using the Lifetech Konar-multifunctional occluder (MFO). (2) From March 2019 to October 2022, 43 consecutive patients were enrolled in the study. Among them, 13 had multifenestrated PmVSD including 5 Gerbode-type defects. (3) There were 23 males/20 females, and the median age was 17 years (range 2-68 years). Trivial aortic regurgitation was noticed in 19 patients. Implantation was successful in all patients under general anesthesia. A retrograde approach was used in 35 patients (81%). The retrograde approach was associated with a lower radiation dose (p = 0.042) and shorter fluoroscopy time (p = 0.002) compared to the antegrade approach. Full occlusion was observed immediately in 12 patients (28%) and in 33 patients (77%) at a median follow-up of 11 months. There were no complications such as embolization, complete atrioventricular block, device dislocation, new onset above grade I, or progression of tricuspid or aortic valve regurgitation. Seven of the thirteen patients with a multifenestrated defect had no residual shunt. The persistent shunts were all trivial intra-prosthetic leaks. (4) MFO is effective and safe for PmVSD closure including multifenestrated/Gerbode-type defects with no complication. However, a longer follow-up remains warranted to establish the safety of this technique.