Anatomic and surgical factors affecting the switch from minimally invasive transthoracic occlusion to open surgery during ventricular septal defect repair

Fang, J.; Xie, Shaobo; Ma, Lunchao; Yang, Chao

doi:10.21037/jtd.2018.01.47

Cited by 4 publications

(6 citation statements)

References 4 publications

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“…Compared with those in previous literature, 12 the proportion of occlusion device shedding or shifting, which are the most common cause of procedure failure, was higher in this study cohort. The rate of VSD closure failure varies because of different VSD locations.…”

Section: Discussioncontrasting

confidence: 86%

“…In this study, 522 children underwent minimally invasive surgical VSD closure, and 19 cases (3.64%) of failure occurred. The failure rate was low compared with that in other studies 3–5 8–12. In the 5 years from 2015 to 2019, the annual failure rate was similar and not significantly different likely due to our team having substantial experience in surgical VSD closure in children.…”

Section: Discussionmentioning

confidence: 47%

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Analysis and comparison of failure causes of minimally invasive surgical closure of ventricular septal defects in children

Jin

Shi

Qian

et al. 2023

World Jnl Ped Surgery

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ObjectivesThe aims of the present study were to explore the causes of minimally invasive surgical ventricular septal defect (VSD) closure failure under transesophageal echocardiography guidance and thus to improve the success rate of surgical VSD closure.MethodsFrom January 2015 to December 2019, 522 children with VSD underwent minimally invasive surgical closure. Nineteen procedures (3.64%) were unsuccessful. The failure causes, VSD locations and surgical incision approaches were retrospectively analyzed.ResultsAmong the 19 patients (3.64%) with unsuccessful outcomes, 18 were switched to cardiopulmonary bypass (CPB) surgery, and 1 was closed successfully using an occlusion device a year later. The causes of failure included occlusion device shedding or shifting (n=6), failure of the guidewire (or the sheath) to pass through a small defect (n=5), device-related valve regurgitation (n=4), significant residual shunt (n=2), ventricular fibrillation (n=1), and continuous sharp blood pressure decreases (n=1). Patients with high VSD had a slightly higher failure rate than those with perimembranous VSD (p=0.049), and its key reason is the high proportion of occlusion device shedding or shifting (p=0.001). No significant difference in the failure rate was found between patients with different surgical incision approaches.ConclusionsMinimally invasive surgery has a high success rate for perimembranous VSDs. Occlusion device shedding or shifting is the most common cause of failure. The shedding or shifting risk of eccentric occlusion devices being used only for high VSDs is much greater than that of concentric occlusion devices being used for perimembranous VSDs, which increases the risk of conversion to CPB surgery for high VSDs.

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Section: Discussioncontrasting

confidence: 86%

Section: Discussionmentioning

confidence: 47%

Analysis and comparison of failure causes of minimally invasive surgical closure of ventricular septal defects in children

Jin

Shi

Qian

et al. 2023

World Jnl Ped Surgery

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“…If closure cannot be achieved or any complication occur, a rapid transition to open-heart surgery is possible [ 2 , 3 , 5 , 7 , 8 , 11 - 13 ] .…”

Section: Discussionmentioning

confidence: 99%

“…Fang et al [ 3 ] analyzed the factors for switching to conventional repair. In their series, residual shunts (8/340; 2.4%) and valvular insufficiency (5/340; 1.5%) were the main factors.…”

Section: Discussionmentioning

confidence: 99%

Hybrid Transthoracic Periventricular Device Closure of Ventricular Septal Defects: SingleCenter Experience

Öztürk

et al. 2021

Braz J Cardiovasc Surg

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Objective To evaluate the efficacy of hybrid transthoracic periventricular device closure of ventricular septal defects (VSDs) in a single center. Methods All patients who underwent hybrid transthoracic periventricular device closure of VSDs between January 2018 and December 2019 were retrospectively analyzed. The preoperative, operative and postoperative findings and clinical follow-ups were reviewed. Results A total of 59 patients underwent the procedure. Transesophageal echocardiographic guidance was used in all procedures. The procedure was successful in 57 procedures (97%). The procedures of two patients were changed to open-heart surgery during the same intervention due to severe aortic insufficiency (the device was not deployed) and significant residual shunt after device deployment. One major complication (1.7%) was observed after the procedure. The patient’s device was dislodged within 12 hours after the procedure, and this patient underwent device extraction and VSD patch closure due to significant residual shunt. Eight (14%) minor complications were observed after the procedure, and three of them persisted during follow-up. Three of these eight complications were incomplete right bundle branch block, one of which resolved during follow-up; two were mild residual shunts, one of which resolved during follow-up; two were mild new-onset tricuspid valve insufficiencies; and one was mild new-onset mitral valve insufficiency; all valvular insufficiencies were resolved during follow-up. Conclusions Hybrid transthoracic periventricular device closure of VSD seems to be a good alternative approach due to its procedural success and low risk rates. The best advantage of the procedure is the possibility of switching to open-heart surgery, if necessary.

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“…This study comprised patients 3 months to 33 years old and weighing 3.5 to 61 kg (mean 14.3 § 6.51 kg). 14 Review of these data indicates that perventricular repair is an early and evolving technology that presents promise as proposed in this issue by Wang et al in a well-trained multidisciplinary setting. 4 Importantly, Wang et al found that the periventricular ventricular septal defect closure technique was well tolerated and associated with fast-track extubation, earlier discharge from the intensive care unit, and earlier hospital discharge compared with the conventional surgical technique with cardiopulmonary bypass.…”

mentioning

confidence: 99%

Transthoracic Ventricular Septal Defect Closure in Children: An Evolving Treatment Strategy as an Alternative to Open Surgical Repair

Stone

Ing

2019

Journal of Cardiothoracic and Vascular Anesthesia

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Anatomic and surgical factors affecting the switch from minimally invasive transthoracic occlusion to open surgery during ventricular septal defect repair

Cited by 4 publications

References 4 publications

Analysis and comparison of failure causes of minimally invasive surgical closure of ventricular septal defects in children

Analysis and comparison of failure causes of minimally invasive surgical closure of ventricular septal defects in children

Hybrid Transthoracic Periventricular Device Closure of Ventricular Septal Defects: SingleCenter Experience

Transthoracic Ventricular Septal Defect Closure in Children: An Evolving Treatment Strategy as an Alternative to Open Surgical Repair

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