Top

Journal of Cardiothoracic Surgery

Published in:

Open Access 01-12-2021 | Ventricular Septal Defect | Research article

Minimally invasive closure of transthoracic ventricular septal defect: postoperative complications and risk factors

Authors: Chunnian Ren, Chun Wu, Zhengxia Pan, Yonggang Li

Published in: Journal of Cardiothoracic Surgery | Issue 1/2021

Abstract

Objectives

To summarize and analyze the clinical characteristics of postoperative complications after minimally invasive closure of transthoracic ventricular septal defect, and to explore the risk factors for its occurrence.

Methods

Retrospectively analyzed the clinical data of 209 patients underwent transthoracic ventricular septal defect closure performed in the Department of Cardiothoracic Surgery, Children’s Hospital of Chongqing Medical University from January 2018 to January 2020, obtained relevant clinical data from the electronic medical record system and summarized their postoperative complications. And used univariate logistics regression and multivariate logistics regression to analyze the risk factors of its occurrence.

Results

The postoperative hospital stay of 27 patients was longer than 9 days. Residual shunt occurred in 33 patients recently after operation. One patient underwent surgical treatment again because of mechanical hemolysis after the operation. Two patients were re-operated 1 month and 10 months after surgery because of persistent moderate to severe aortic regurgitation. After surgery, 3 patients underwent pericardiocentesis due to a large amount of pericardial effusion, and 2 patients developed a new atrioventricular block after the operation. No other serious adverse events occurred. Multivariate logistic regression analysis showed that the size of VSD defect (OR: 1.494, 95% Cl: 1.108–2.013, P value: 0.008) was related to long postoperative hospitalization. The residual shunt is related to the size of the occluder (OR: 1.452, 95%Cl: 1.164–1.810, P value: 0.001). In the univariate logistics regression analysis, no risk factors related to serious adverse events were found.

Conclusions

The minimally invasive closure of transthoracic ventricular septal defect is very effective, with no mortality and low incidence of serious adverse events after surgery. The size of the defect is related to the long postoperative hospitalization, and the size of the occluder is related to the residual shunt in the early postoperative period. No risk factors related to the occurrence of serious adverse events after the operation were found.

Fang G, et al. The comparison of perventricular device closure with transcatheter device closure and the surgical repair via median sternotomy for perimembranous ventricular septal defect. Ann Thorac Cardiovasc Surg. 2018;24(6):308–14. https://doi.org/10.5761/atcs.oa.18-00085.CrossRefPubMedPubMedCentral

Wang S, Zhuang Z, Zhang H, Zhen J, Lu Y, Liu J, et al. Perventricular closure of Perimembranous ventricular Septal defects using the concentric Occluder device. Pediatr Cardiol. 2014;35(4):580–6. https://doi.org/10.1007/s00246-013-0823-0.CrossRefPubMed

Zhang X, Xing Q, Wu Q. Treatment of Perimembranous ventricular Septal defect in children weighing less than 15 kg: minimally invasive periventricular device occlusion versus right subaxillary small incision surgical repair. Thorac Cardiovasc Surg. 2015;63:409–18. https://doi.org/10.1055/s-0035-1546297.CrossRefPubMed

Chen Q, et al. Intraoperative device closure of isolated ventricular Septal defects: experience on 1,090 cases. Ann Thorac Surg. 2018;105:1797–802. https://doi.org/10.1016/j.athoracsur.2018.02.059.CrossRefPubMed

Jacobs M, et al. An empirically based tool for analyzing morbidity associated with operations for congenital heart disease. J Thorac Cardiovasc Surg. 2013;145:1046–1057.e1041. https://doi.org/10.1016/j.jtcvs.2012.06.029.CrossRefPubMed

Xu H, Inamdar K, Firoj K, Zhao W. Perventricular device closure of ventricular defects in 235 young children: a single-center experience. J Thorac Cardiovasc Surg. 2013;146:1551–3. https://doi.org/10.1016/j.jtcvs.2013.08.004.CrossRefPubMed

Walsh M, Bialkowski J, Szkutnik M, Pawelec-Wojtalik M, Bobkowski W, Walsh KP. Atrioventricular block after transcatheter closure of perimembranous ventricular septal defects. 2006;92(9):1295–7. https://doi.org/10.1136/hrt.2005.084988.

Yang R, Kong XQ, Sheng YH, Zhou L, Xu D, Yong YH, et al. Risk factors and outcomes of post-procedure heart blocks after Transcatheter device closure of Perimembranous ventricular Septal defect. JACC Cardiovasc Interv. 2012;5(4):422–7. https://doi.org/10.1016/j.jcin.2012.01.015.CrossRefPubMed

Zhou T, Shen XQ, Zhou SH, Fang ZF, Hu XQ, Zhao YS, et al. Atrioventricular block: a serious complication in and after Transcatheter closure of Perimembranous ventricular Septal defects. Clin Cardiol. 2008;31(8):368–71. https://doi.org/10.1002/clc.20243.CrossRefPubMedPubMedCentral

10.

Butera G, Massimo C, Mario CJC. Late complete atriovenous block after percutaneous closure of a perimembranous ventricular septal defect. Catheter Cardiovasc Interv. 2006;67:938–41. https://doi.org/10.1002/ccd.20696.CrossRefPubMed

11.

Deng X, Huang P, Luo J, Chen R, Yang G, Chen W, et al. Residual shunts following isolated surgical ventricular Septal defect closure: risk factors and spontaneous closure. Pediatr Cardiol. 2020;41(1):38–45. https://doi.org/10.1007/s00246-019-02218-9.CrossRefPubMed

12.

Dodge-Khatami A, Knirsch W, Tomaske M, Prêtre R, Bettex D, Rousson V, et al. Spontaneous closure of small residual ventricular Septal defects after surgical repair. Ann Thorac Surg. 2007;83(3):902–5. https://doi.org/10.1016/j.athoracsur.2006.09.086.CrossRefPubMed

13.

Mahimarangaiah J, Subramanian A, Kikkeri Hemannasetty S, Chandra S, Karur S, Mandikal Kodandaramasastry U, et al. Transcatheter closure of perimembranous ventricular septal defects with ductal occluders. Cardiol Young. 2015;25(5):918–26. https://doi.org/10.1017/s1047951114001255.CrossRefPubMed

14.

Bai Y, Liu J, Qin Y, Wu H, Zhao X. Percutaneous closure of Perimembranous ventricular Septal defect with modified double-disk Occluder: what is the outcome at 10-year follow-up? Congenit Heart Dis. 2016;11:45–51. https://doi.org/10.1111/chd.12284.CrossRefPubMed

15.

Anderson B, et al. Contemporary outcomes of surgical ventricular septal defect closure. J Thorac Cardiovasc Surg. 2013;145(3):641–7. https://doi.org/10.1016/j.jtcvs.2012.11.032.CrossRefPubMed

Title: Minimally invasive closure of transthoracic ventricular septal defect: postoperative complications and risk factors
Authors: Chunnian Ren
Chun Wu
Zhengxia Pan
Yonggang Li
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Ventricular Septal Defect
Ventricular Septal Defect
Published in: Journal of Cardiothoracic Surgery / Issue 1/2021
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-021-01415-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Minimally invasive closure of transthoracic ventricular septal defect: postoperative complications and risk factors

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Epidemiological and clinical characteristics of road traffic crashes related thoracic traumas: analysis of 5095 hospitalized chest injury patients

Preliminary study of the characteristics of rib fractures and their impact on pulmonary ventilatory function

Preoperative virtual simulation for synchronous multiple primary lung cancers using three-dimensional computed tomography lung reconstruction: a case report

Comparison of flexible, open with semi-rigid, closed annuloplasty-rings for mitral valve repair

Aortic valve surgery for aortic regurgitation caused by Libman-Sacks endocarditis in a patient with primary antiphospholipid syndrome: a case report

Chest wall and diaphragm reconstruction; a technique not well established in literature – case report