Midterm Results of Hybrid Perventricular Closure of Doubly Committed Subarterial Ventricular Septal Defects in Pediatric Patients

Abstract

OBJECTIVES: To evaluate the safety and efficiency of using hybrid perventricular closure in treating pediatric patients with the doubly committed subarterial ventricular septal defects (VSD). METHODS: Ninety pediatric patients with doubly committed subarterial VSD were enrolled from October 2007 to September 2010 in this retrospective study. Among them, 41 underwent open-heart surgery (surgical group), while 49 underwent perventricular device closure (perventricular group). RESULTS: There was no difference in age (4.36 ± 3.21 vs. 5.82 ± 4.32 years, p > 0.05) between the two groups. VSD diameter was significantly larger in the surgical group than in the perventricular group (5.03 ± 1.31 vs. 6.03 ± 1.94 mm, p < 0.05). There were no major complications such as death, severe valve insufficiency, significant residual shunt, or lethal arrhythmias in two groups. The perventricular group was associated with a significant reduction of transfusion rate (18.4% vs. 97.6%, p < 0.05) as well as mean intensive care unit (ICU) stay (0.97 ± 0.53 vs. 2.78 ± 3.00 days, p < 0.05) in comparison with the surgical group. No difference was noted for complete closure rate between two groups at discharge (97.6% vs. 85.7%, p > 0.05) as well as during follow-up (97.6% vs. 95.9%, p > 0.05). Perventricular device closure was not associated with an increased risk of procedure-induced aortic insufficiency compared with the open-heart surgical group during follow-up (14.3% vs. 14.6%, p > 0.05). CONCLUSIONS: Hybrid perventricular closure may be an alternative to open-heart surgery in selected pediatric patients with doubly committed subarterial VSD.