Comparison of Transthoracic Device Closure and Surgical Repair with Right Submammary or Right Infra-axillary Thoracotomy for Perimembranous VSD
17 February 2018
07 May 2018
28 June 2018 (eFirst)
Background Transthoracic device closure (TTDC) and surgical repair with right infra-axillary thoracotomy (SRRIAT) or with right submammary thoracotomy (SRSMT) are all the primary alternative treatments for restrictive perimembranous ventricular septal defect (pmVSD). However, few studies have compared them in terms of effectiveness and complications.
Methods Patients with restrictive pmVSD undergoing TTDC, or SRRIAT, or SRSMT from March 2016 to February 2017 were retrospectively reviewed in our cardiac center. There were no differences in age (1.3 ± 1.2 vs 1.1 ± 1.1 vs 1.2 ± 1.1 years), gender (35/37 vs 30/33 vs 29/29), body weight (8.3 ± 2.6 vs 8.2 ± 2.4 vs 8.1 ± 2.5 kg), and size of VSD (4.2 ± 1.1 vs 5.2 ± 1.3 vs 5.1 ± 1.2 mm) distribution between the three groups.
Results The procedure success rates were similar in the three groups. The TTDC group had the shortest operative time, postoperative mechanical ventilation time, duration of intensive care, postoperative length of hospital stay, medical cost, and length of the incision. There were no significant differences in terms of operative time, aortic cross-clamping time, duration of cardiopulmonary bypass (CPB), blood transfusion volume, mechanical ventilation time, duration of intensive care, duration of hospital stays, pleural fluid drainage, or cost between the SRSMT and SRRIAT groups. No significant differences were noted in terms of major adverse events.
Conclusions TTDC, SRRIAT, and SRSMT all showed excellent outcomes and cosmetic appearances for selected VSD patients. TTDC had advantages over SRRIAT and SRSMT in terms of short operation duration and smaller incision size and shorter durations of intensive care and hospital stays.
- 1 Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39 (12) 1890-1900
- 2 Moritz A, Ozaslan F, Dogan S, Abdel-Rahman U, Aybek T, Wimmer-Greinecker G. Closure of atrial and ventricular septal defects should be performed by the surgeon. J Interv Cardiol 2005; 18 (06) 523-527
- 3 Mavroudis C, Baker CL, Idriss FS. Ventricular septal defect. In: Mavroudis C, Baker CL. , eds. Pediatric Cardiac Surgery. 3rd ed. Philadelphia, Pennsylvania: Mosby; 2003: 298-320
- 4 Wang Q, Li Q, Zhang J, Wu Z, Zhou Q, Wang DJ. Ventricular septal defects closure using a minimal right vertical infraaxillary thoracotomy: seven-year experience in 274 patients. Ann Thorac Surg 2010; 89 (02) 552-555
- 5 Giamberti A, Mazzera E, Di Chiara L, Ferretti E, Pasquini L, Di Donato RM. Right submammary minithoracotomy for repair of congenital heart defects. Eur J Cardiothorac Surg 2000; 18 (06) 678-682
- 6 Cao H, Chen Q, Zhang GC, Chen LW, Qiu ZH, Xu F. Transthoracic Subarterial Ventricular Septal Defect Occlusion Using a Minimally Invasive Incision. J Card Surg 2016; 31 (06) 398-402
- 7 Yang L, Tai BC, Khin LW, Quek SC. A systematic review on the efficacy and safety of transcatheter device closure of ventricular septal defects (VSD). J Interv Cardiol 2014; 27 (03) 260-272
- 8 Moodie DS. Technology iInsight: transcatheter closure of ventricular septal defects. Nat Clin Pract Cardiovasc Med 2005; 2 (11) 592-596
- 9 Yang X, Wang D, Wu Q. Repair of atrial septal defect through a minimal right vertical infra-axillary thoracotomy in a beating heart. Ann Thorac Surg 2001; 71 (06) 2053-2054
- 10 Schreiber C, Bleiziffer S, Kostolny M. , et al. Minimally invasive midaxillary muscle sparing thoracotomy for atrial septal defect closure in prepubescent patients. Ann Thorac Surg 2005; 80 (02) 673-676
- 11 Prêtre R, Kadner A, Dave H, Dodge-Khatami A, Bettex D, Berger F. Right axillary incision: a cosmetically superior approach to repair a wide range of congenital cardiac defects. J Thorac Cardiovasc Surg 2005; 130 (02) 277-281
- 12 De Mulder W, Vanermen H. Repair of atrial septal defects via limited right anterolateral thoracotomy. Acta Chir Belg 2002; 102 (06) 450-454
- 13 Däbritz S, Sachweh J, Walter M, Messmer BJ. Closure of atrial septal defects via limited right anterolateral thoracotomy as a minimal invasive approach in female patients. Eur J Cardiothorac Surg 1999; 15 (01) 18-23
- 14 Mishaly D, Ghosh P, Preisman S. Minimally invasive congenital cardiac surgery through right anterior minithoracotomy approach. Ann Thorac Surg 2008; 85 (03) 831-835
- 15 Massetti M, Babatasi G, Rossi A. , et al. Operation for atrial septal defect through a right anterolateral thoracotomy: current outcome. Ann Thorac Surg 1996; 62 (04) 1100-1103
- 16 Vida VL, Padalino MA, Boccuzzo G. , et al. Minimally invasive operation for congenital heart disease: a sex-differentiated approach. J Thorac Cardiovasc Surg 2009; 138 (04) 933-936
- 17 Hu CX, Tan J, Chen S, Ding H, Xu ZW. Comparison of clinical outcomes and postoperative recovery between two open heart surgeries: minimally invasive right subaxillary vertical thoracomy and traditional median sternotomy. Asian Pac J Trop Med 2014; 7 (08) 625-629
- 18 Ding C, Wang C, Dong A. , et al. Anterolateral minithoracotomy versus median sternotomy for the treatment of congenital heart defects: a meta-analysis and systematic review. J Cardiothorac Surg 2012; 7: 43
- 19 Gan C, An Q, Lin K. , et al. Perventricular device closure of ventricular septal defects: six months results in 30 young children. Ann Thorac Surg 2008; 86 (01) 142-146
- 20 Zeng XJ, Sun SQ, Chen XF. , et al. Device closure of perimembranous ventricular septal defects with a minimally invasive technique in 12 patients. Ann Thorac Surg 2008; 85 (01) 192-194
- 21 Quansheng X, Silin P, Zhongyun Z. , et al. Minimally invasive perventricular device closure of an isolated perimembranous ventricular septal defect with a newly designed delivery system: preliminary experience. J Thorac Cardiovasc Surg 2009; 137 (03) 556-559
- 22 Pan S, Xing Q, Cao Q. , et al. Perventricular device closure of doubly committed subarterial ventral septal defect through left anterior minithoracotomy on beating hearts. Ann Thorac Surg 2012; 94 (06) 2070-2075
- 23 Predescu D, Chaturvedi RR, Friedberg MK, Benson LN, Ozawa A, Lee KJ. Complete heart block associated with device closure of perimembranous ventricular septal defects. J Thorac Cardiovasc Surg 2008; 136 (05) 1223-1228
- 24 Bai Y, Xu XD, Li CY. , et al. Complete atrioventricular block after percutaneous device closure of perimembranous ventricular septal defect: a single-center experience on 1046 cases. Heart Rhythm 2015; 12 (10) 2132-2140
- 25 Chen Q, Cao H, Zhang GC, Chen LW, Li QZ, Qiu ZH. Atrioventricular block of intraoperative device closure perimembranous ventricular septal defects; a serious complication. BMC Cardiovasc Disord 2012; 12: 21