Minimally invasive perventricular versus open surgical ventricular septal defect closure in infants and children: a randomised clinical trial

Liu, Hong; Lu, Fengxia; Zhou, Jie; Yan, Fei; Qian, Sichong; Li, Xinya; Zheng, Siming; Chen, Jun-quan; Zhong, Ji‐sheng; Feng, Qingxiang; Ding, Tong; Fan, Jin‐Hu; Gu, Haotian; Liu, Xiaocheng

doi:10.1136/heartjnl-2017-312793

Cited by 21 publications

(49 citation statements)

References 28 publications

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“…Transthoracic device closure of ventricular septal defect (VSD) in children, which combines the advantages of surgical repair and transcatheter device closure of VSD, has been widely used in the clinic in recent years, especially in China [ 1 , 2 ] . The technique has the advantages of a small incision, without the need for cardiopulmonary bypass, a simple operation process and quick recovery.…”

Section: Introductionmentioning

confidence: 99%

Sufentanil Reduces Emergence Delirium in Children Undergoing Transthoracic Device Closure of VSD After Sevoflurane-Based Cardiac Anesthesia

Xu¹,

Chen²,

Huang³

et al. 2020

Braz J Cardiovasc Surg

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Objective The aim of this study was to evaluate whether sufentanil can reduce emergence delirium in children undergoing transthoracic device closure of ventricular septal defect (VSD) after sevoflurane-based cardiac anesthesia. Methods From February 2019 to May 2019, 68 children who underwent transthoracic device closure of VSD at our center were retrospectively analyzed. All patients were divided into two groups: 36 patients in group S, who were given sufentanil and sevoflurane-based cardiac anesthesia, and 32 patients in group F, who were given fentanyl and sevoflurane-based cardiac anesthesia. The following clinical data were recorded: age, sex, body weight, operation time, and bispectral index (BIS). After the children were sent to the intensive care unit (ICU), pediatric anesthesia emergence delirium (PAED) and face, legs, activity, cry, consolability (FLACC) scale scores were also assessed. The incidence of adverse reactions, such as nausea, vomiting, drowsiness and dizziness, was recorded. Results There was no significant difference in age, sex, body weight, operation time or BIS value between the two groups. Extubation time (min), PEAD score and FLACC scale score in group S were significantly better than those in group F ( P <0.05). No serious anesthesia or drug-related side effects occurred. Conclusions Sufentanil can be safely used in sevoflurane-based fast-track cardiac anesthesia for transthoracic device closure of VSD in children. Compared to fentanyl, sufentanil is more effective in reducing postoperative emergence delirium, with lower analgesia scores and greater comfort.

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Section: Introductionmentioning

confidence: 99%

Sufentanil Reduces Emergence Delirium in Children Undergoing Transthoracic Device Closure of VSD After Sevoflurane-Based Cardiac Anesthesia

Xu¹,

Chen²,

Huang³

et al. 2020

Braz J Cardiovasc Surg

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“…In 2019, authors from Guangzhou reported an alternative method using minimal mid-partial sternotomy in 13 patients (22). Minimally invasive perventricular closure of doubly committed subarterial VSD was also reported, but this technique lacks of long term follow-up results (2). In our opinion, surgical closure from LALT is preferred in such patient groups.…”

Section: Discussionmentioning

confidence: 89%

Individualized Strategy of Minimally Invasive Cardiac Surgery in Congenital Cardiac Septal Defects

Zhu¹,

Zhang²,

Bao³

et al. 2021

Preprint

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Background: Intracardiac septal defect tends to be repaired by minimally invasive surgery in both children and adults. This study summarized our strategy of minimally invasive therapy using various lateral mini-thoracotomies in patients with congenital septal defect. Methods: Four hundred and seventy-two patients who underwent minimally invasive repair of intracardiac septal defects (Atrial septal defect, ASD; ventricular septal defect, VSD; atrioventricular septal defect, AVSD) between January 2012 and June 2020 were retrospectively reviewed. Those who underwent device closure were excluded. The minimally invasive strategy included three groups. First, right sub-axillary vertical incision group (RSAVI group, N=335, 192 ASDs, 135 VSDs and 8 AVSDs; Second, right anterolateral thoracotomy group (RALT group, N=132, 77 ASDs, 51 VSDs and 4 AVSDs; Third, left anterolateral thoracotomy group (LALT group, N=5, all of them were sub-pulmonary VSDs).Results: Concomitant surgeries included 9 cases of right ventricular outflow tract obstruction relief, 9 mitral repairs and 37 tricuspid repairs. There was one transition from thoracotomy to sternotomy. Three patients required second pump run for residual lesions (2 residual shunts and 1 mitral regurgitation). The age and body weight of RSAVI group were significantly lower than those of RALT and LALT groups. The mean cardiopulmonary bypass time was 67.3±11.3 min and cross clamp time was 38.1±8.9 min. There was no post-operative death, and complications included 1 chest exploration for bleeding, 1 redo operation due to patch dehiscence during the same admission, 1 transient neural dysfunction, 3 diaphragmatic paresis and 13 atelectasis. The median stay in ICU was 2 days, while the median post-operative hospitalization was 6 days. The echocardiography results before discharge indicated no significant residual lesions. There was no reoperation, no new onset of chest deformities and no sclerosis during the follow up. Conclusions: The commonly seen intracardiac septal defects can be safely and effectively repaired by minimally invasive surgery with good cosmetic results. Right sub-axillary vertical incision is suitable in infants and young children, while right anterior mini-thoracotomy is more commonly used in adolescents and adults. Left anterior mini-thoracotomy is an alternative incision to repair sub-pulmonary artery VSD.

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“…Liu H et al conducted an open-label randomised controlled trial comparing the traditional open surgical approach to the new minimally invasive periventricular approach. 10 This study found that…”

Section: Indications For Repair Of Vsdmentioning

confidence: 90%

Ventricular septal defect: diagnosis and treatments in the neonates: a systematic review

et al. 2020

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Background: Medical advancements have encouraged minimally invasive surgical repair of congenital heart defects such as ventricular septal defects (VSDs), and the diagnostic process can now be carried out using non-traditional techniques such as pulse oximetry. This, in turn, has improved clinical outcomes with reduced complication rates post-surgery. However, the variations in type of VSDs, age of patient, comorbidities, and access to closure devices may limit the efficacy of surgical advancements. Methods: Articles were identified amongst Scopus, MEDLINE, and PubMed using various relevant search strings using PRISMA guidelines. Of the 115 articles initially extracted, 10 were eventually reviewed after duplicates and irrelevant studies were removed. Results: Of the 24 eligible articles, 10 papers were selected for analysis. Minimally invasive approaches to VSD repair was associated with satisfactory short-term outcomes when compared to open repair. For diagnosis of congenital VSD, whilst recent advances such as pulse oximetry method and genome analysis are more sensitive, the limited availability and access to such investigatory methods must be recognised. Conclusion: Pulse oximetry and fetal echocardiography are established non-invasive diagnostic tools for VSD. The recent advances in minimally invasive treatment options including periventricular approach and transcatheter techniques have improved patient outcomes, yet at the expense of higher residual rates. Careful patient selection for each technique and follow-up should be planned through multidisciplinary team meetings.

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Minimally invasive perventricular versus open surgical ventricular septal defect closure in infants and children: a randomised clinical trial

Abstract: NCT02794584 ;Results.

Cited by 21 publications

References 28 publications

Sufentanil Reduces Emergence Delirium in Children Undergoing Transthoracic Device Closure of VSD After Sevoflurane-Based Cardiac Anesthesia

Sufentanil Reduces Emergence Delirium in Children Undergoing Transthoracic Device Closure of VSD After Sevoflurane-Based Cardiac Anesthesia

Individualized Strategy of Minimally Invasive Cardiac Surgery in Congenital Cardiac Septal Defects

Ventricular septal defect: diagnosis and treatments in the neonates: a systematic review

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