Minimally Invasive Perventricular Device Closure of Ventricular Septal Defect:a Comparative Study in 80 Patients

Xin-chao Yang; De-bin Liu

摘要

Objective To evaluate the efficacy of minimally invasive perventricular device closure of ventricular septal defect (VSD). Methods Between September 2011 and February 2013, we collected 40 patients who underwent perventricular closure via a small lower sternal incision (minimally invasive group), aged 15.5±3.5 years (12 months to 32 years) with a body weight of 24.2±7.5 kg (10.8-58.0 kg). The mean size of VSD was 5.6±0.5 mm (2-14 mm). Another 40 patients were included as the surgical group, receiving the conventional surgical repair of VSD. The device of the minimally invasive group was released under the guidance of transesophageal echocardiography. Success rate, cardiac indicators, and clinical outcomes of the 2 groups were compared. Results The patients in the surgical group and those in the minimally invasive group showed similar results in success rate (both 97.5%). The procedure time, intensive care unit stay, hospital stay, and postoperative recovery time in the minimally invasive group were significantly shorter than those in the surgical group (58±21 minutes versus 145±26 minutes, 2±1 days versus 8±3 days, 5±1 days versus 16±6 days, 3±1 days versus 90±20 days, all P<0.05). The minimally invasive group had a higher incidence of conduction anomalies (17.5%versus 2.5%, P<0.05). In the follow-up period of 3-12 months, there was no new residual shunt, noticeable aortic regurgitation, significant arrhythmias, or device failure except for new complications in the surgical group. Conclusions The success rate of minimally invasive perventricular device closure of VSD under transesophageal echocardiography guidance is similar to that of conventional surgical repair, but the short-term outcomes of the minimally invasive approach is much better. Long-term follow-up is necessary to confirm the effectiveness of this technique.

机译：目的评估微创室间隔缺损（VSD）的治疗效果。方法在2011年9月至2013年2月期间，我们收集了40例通过小胸骨下切口（微创组）进行脑室闭合手术的患者，年龄15.5±3.5岁（12个月至32岁），体重为24.2± 7.5公斤（10.8-58.0公斤）。 VSD的平均大小为5.6±0.5毫米（2-14毫米）。另有40例患者作为手术组，接受了VSD的常规手术修复。在经食管超声心动图检查的指导下，释放了微创治疗仪。比较两组的成功率，心脏指标和临床结局。结果手术组和微创组的患者成功率相似（均为97.5％）。微创治疗组的手术时间，重症监护病房住院时间，住院时间和术后恢复时间明显短于外科手术组（58±21分钟对145±26分钟，2±1天对8±3天，5±1天与16±6天，3±1天与90±20天，所有P <0.05）。微创组的传导异常发生率较高（17.5％比2.5％，P <0.05）。在3到12个月的随访期内，除外科组出现新的并发症外，没有新的残余分流，主动脉反流，明显的心律不齐或装置故障。结论在经食管超声心动图指导下，VSD的微创心室设备闭合成功率与常规外科手术修复相似，但微创方法的短期效果要好得多。需要长期随访以确认该技术的有效性。

Minimally Invasive Perventricular Device Closure of Ventricular Septal Defect:a Comparative Study in 80 Patients

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