Comparison of the clinical effect between the lower sternal incision and the left parasternal fourth intercostal incision in the transthoracic closure of ventricular septal defect

Ma, Jun; Shangguan, Wenlin; Liao, Dong-Shan

doi:10.1186/s13019-021-01543-6

Cited by 3 publications

(2 citation statements)

References 19 publications

(23 reference statements)

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“…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%

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: 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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“…With advancements in modern surgical techniques, the aim is to achieve the effectiveness of surgery and cosmetic improvement ( 11 ). However, surgeons face the challenges of obtaining optimal esthetics and clear surgical vision.…”

Section: Discussionmentioning

confidence: 99%

Transthoracic device closure of perimembranous ventricular septal defect via a small left intercostal incision in children

Xie,

Zhang,

et al. 2023

Front. Cardiovasc. Med.

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BackgroundIn children with perimembranous ventricular septal defect, surgical repair requires sternotomy and leaves unsightly scars, which can trigger long-term physical and psychological distress. However, transcatheter device closure is limited by vascular diameter, radiographic exposure, and expensive DSA equipment. We used an ultra-small left intercostal incision for transthoracic device closure to avoid the above problems and investigated its safety and feasibility by comparing it with surgical repair.MethodsThis study enrolled 358 children with perimembranous ventricular septal defect. Among them, 152 patients were treated by surgical closure and 206 by transthoracic device closure via an ultra-small left intercostal incision. Perioperative clinical data and postoperative follow-up results were collected and analyzed retrospectively.ResultsThe success rate was similar (P = 0.265) in the two groups: 203/206 patients in the device group vs. 152/152 patients in the surgical group. The operative time, intensive care unit time, mechanical ventilation time, and postoperative hospital stay were significantly shorter in the device group than in the surgical group. Although the incision length of the device group (1.1 ± 0.2 cm) was significant shorter (P < 0.001) than that of the surgical group (6.7 ± 1.5 cm), there was no difference in hospitalization costs between the two groups (P = 0.099). Except for small residual shunt (16/206 vs. 3/152, P = 0.017), the incidence of complications in the device group was lower or equal to that in the surgical group, and all small residual shunt disappeared during follow-up. There was no thoracic deformity in the device group, compared with 11 cases in the surgery group during follow-up (P < 0.001).ConclusionsTransthoracic device closure via an ultra-small left intercostal incision under transesophageal echocardiography guidance is safe and feasible. With appropriate indications, it can be a suitable alternative to surgical closure for treating perimembranous ventricular septal defect in children.

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Device closure via minimally invasive left intercostal incision in children with perimembranous ventricular septal defect

Xu,

Zeng,

Xie

et al. 2024

Sci Rep

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When treating perimembranous ventricular septal defect, median sternotomy leads to unsightly scar, right subaxillary thoracotomy requires cardiopulmonary bypass, and transcatheter device closure constrained by vascular condition. Using small left intercostal incision, we employed transthoracic device closure to get around these issues. During this study, right subaxillary thoracotomy was used for surgical repair in 117 patients (Surgical group), whereas small left intercostal incision was used for transthoracic device closure in 131 patients (Device group). Retrospective data collection and analysis were conducted. The success rate was comparable (117/117 vs. 130/131, P = 1.000). The device group experienced notably reduced operating time, mechanical ventilation duration, ICU stay, and postoperative hospital stay (All P < 0.001). Given that the device group’s incision was much smaller than the surgical group’s (1.1 ± 0.3 vs. 6.8 ± 1.6 cm, P < 0.001), blood transfusion or drainage tube was not needed. The device group observed a lower frequency of complications, with the exception of small residual shunt. It is feasible and safe to perform transthoracic device closure in children with perimembranous ventricular septal defects via small left intercostal incision. It can be a good minimally invasive substitute for surgical closure when utilized properly.

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Comparison of the clinical effect between the lower sternal incision and the left parasternal fourth intercostal incision in the transthoracic closure of ventricular septal defect

Cited by 3 publications

References 19 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

Transthoracic device closure of perimembranous ventricular septal defect via a small left intercostal incision in children

Device closure via minimally invasive left intercostal incision in children with perimembranous ventricular septal defect

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