A Comparative Study of Perventricular and Percutaneous Device Closure Treatments for Isolated Ventricular Septal Defect: A Chinese Single-Institution Experience

Long-term Consequences of Ventricular Septal Defect Closure Using Nit-Occlud Le VSD Coil Device: A Systematic Review and Meta-Analysis

BACKGROUND

The successful management of ventricular septal defect (VSD) has been possible through the development of advanced techniques. In this regard, percutaneous VSD closure by employing different types of occluders as an alternative for surgery can help to achieve the most desirable postprocedural consequences. However, the studies reported contradictory results on the use of different brands of VSD occluders. Herein, we performed a systematic review and meta-analysis of published studies to assess pooled long-term success rate and potential complications of using the Nit-Occlud Lê VSD coil for VSD closure.

MATERIALS AND METHODS

Two reviewers began to deeply search the various databases for all eligible studies in accordance with the considered keywords. The inclusion criterion for retrieving the studies was to describe the mid-term or long-term consequences of VSD closing by the Nit-Occlud Lê VSD coil device. In the final, eight articles were eligible for the analysis. The follow-up time of the studies ranged from 6 months to 5 years.

RESULTS

The success rate of the procedure ranged from 87.0% to 100% considering the weight of each study, the pooled success rate of VSDs closure by Nit-Occlud Lê VSD coil device was 93.1% (95% confidence interval [CI]: 89.9% to 95.5%). The pooled prevalence of postprocedural residual shunt was estimated to be 9.6% (95%CI: 6.8% to 13.4%). The corrected pooled prevalence of trivial mild aortic regurgitation (AR) was 2.9% (95%CI: 1.5% to 5.4%); however, moderate-to-severe AR and complete heart block or right bundle branch block were shown to be rare.

CONCLUSION

VSD closure using a Nit-Occlud Lê VSD coil device can lead to a high success rate with low rates of residual shunt, cardiac conductive or vascular disturbances.

Transthoracic closure of ventricular septal defects guided by transesophageal echocardiography

Background

This study aims to investigate the effectiveness and safety of transthoracic closure of ventricular septal defects totally guided by transesophageal echocardiography.

Methods

A total of 119 patients (62 males, 57 females; mean age 2.1±5.2 years; range, 11 months to 50 years) who underwent transthoracic closure of ventricular septal defects in our center between April 2017 and November 2018 were included. All patients were evaluated in terms of the diameter and morphological features of ventricular septal defects via transesophageal echocardiography. During the procedure, transthoracic echocardiography was used as the only guiding tool for occluder implantation.

Results

Of the patients, 116 underwent successful transthoracic device closure procedure. Two patients were switched to surgical repair due to new-onset aortic regurgitation in one patient and severe arrhythmias after device release in the other patient. One patient underwent a second operation for occluder migration during the hospital stay. In the first attempt, 106 ventricular septal defect occluders were correctly positioned. Transthoracic echocardiography revealed the insecure position or significant residual shunting in 10 patients. The original device was replaced with an asymmetric device or a more extensive occluder, and satisfactory results were finally obtained. No complications such as new-onset aortic regurgitation, residual shunt, complete heart block, or device dislodgement occurred during follow-up.

Conclusion

Transthoracic closure of ventricular septal defects under the total guidance of transthoracic echocardiography is a safe and effective method.

Comparisons of perventricular device closure, conventional surgical repair, and transcatheter device closure in patients with perimembranous ventricular septal defects: a network meta-analysis

BACKGROUND

Treatments for perimembranous ventricular septal defects (pmVSD) mainly include conventional surgical repair (CSR), transcatheter device closure (TDC), and perventricular device closure (PDC). We aimed to perform a network meta-analysis to compare the three approaches in patients with pmVSD.

METHODS

We searched for comparative studies on device closure and conventional repair for pmVSD to April 2020. A network meta-analysis was performed under the frequentist frame with risk ratio and 95% confidence interval. The main outcome was the procedural success rate. Additional outcomes were postoperative complications, including residual shunt, intra-cardiac conduction block, valvular insufficiency, incision infection, and pericardial effusion.

RESULTS

Twenty-four studies of 8113 patients were included in the comparisons. The pooled estimates of success rate favored the CSR compared with the PDC. No significant differences of success rate were found in the TDC versus CSR and the PDC versus TDC. The pooled estimates of incidences of the residual shunt, new tricuspid regurgitation, incision infection, and pericardial effusion favored the PDC compared with the CSR. There were no significant differences between the PDC and TDC approaches in all outcomes except new aortic regurgitation.

CONCLUSION

The PDC technique not only reduces the risk of significant complications compared with the CSR, but also produces not inferior results compared with the TDC in selected pmVSD patients.

PROSPERO REGISTRATION NUMBER

CRD42019125257.

A comparative study of minimal lower-sternal incision device closure, minimal right thoracic incision device closure, and midsternal open repair of isolated perimembranous VSD, a retrospective cohort study

OBJECTIVE

To compare transthoracic device closure via a minimal lower-sternal incision or minimal right thoracic incision and surgical repair via midsternal incision for perimembranous ventricular septal defect (VSD).

METHODS

We retrospectively analyzed the clinical data of 147 patients with isolated perimembranous VSD who were treated in our hospital from June 2017 to December 2017. According to the therapeutic approaches, the patients were divided into group A(transthoracic device closure via a minimal lower-sternal incision), group B((transthoracic device closure via a minimal right thoracic incision) and group C(surgical repair via midsternal incision). The clinical data of the three groups were statistically analyzed.

RESULTS

The three groups of patients had satisfactory outcomes for VSD closure. No complications, including third-degree atrioventricular block, large residual shunt requiring re-operation, newly moderate-severe aortic or tricuspid regurgitation, occluder detachment were reported. Compared with group C, the operative time, duration of mechanical ventilation, length of ICU stay, drainage volume, blood transfusion volume, length of the incision, and length of postoperative hospital stay were significantly lower in the device groups (A and B).

CONCLUSION

Transthoracic device closure via a minimal lower-sternal incision or minimal right thoracic incision and surgical repair via midsternal incision are sufficiently safe procedures for the treatment of isolated perimembranous VSD and can achieve satisfactory early clinical efficacy. Both device approaches have the advantages of a quick recovery and good cosmetic appearance of the incision.