Objective To evaluate the safety and the efficiency of two kinds of approach for treatment of subaortic ventricular septal defect in children
Methods A total of 213 patients with subaortic ventricular septal defect underwent surgical treatment was divided into two groups. In group A, 62 patients underwent device closure attempts without pump. In group B, 151 patients underwent open-heart surgery under cardiopulmonary bypass. The clinical data were collected and a retrospective analysis was accomplished to evaluate the safety and the efficiency of two kinds of approach for treatment of subaortic ventricular septal defect in children.
Results There was no death or severe adverse event in this cohort. In group A, 52 (83.9%) cases were successful, but 10 (16.1%) patients were successfully converted to open-heart surgery due to tricuspid regurgitation, aortic regurgitation or residual shunt. In group B, all patients underwent traditional repair procedure successfully. Followup ranged from 4 months to 19 months (mean, 11.6 ± 3.8 months). There were statistically significant differences (P < 0.05) in time of operation, time of mechanical ventilation after operation, time of ICU, postoperation hospitalisation duration and usage of blood between groups. No acute procedural complications and severe adverse events (defined as death, valve injury, complete AVB and embolism) occurred. IRBBB were found in 3 patients (5.8%) of group A and 18 patients (11.9%) of group B when discharged. Atrioventricular regurgitation decreased in 4 patients (7.7%) but new trivial regurgitation were detected in other 5 patients (9.6%) in group A. Atrioventricular regurgitation also decreased in 18 patients (11.9%) but new trivial regurgitation were detected in other 18 patients (11.9%) in group B. Trivial residual shunt without murmur were found in 3 patients (5.8%) of group A and 7 patients (4.6%) of group B. Pericardial effusion occurred in 1 patient (1.9%) of group A and 5 patient (3.3%) of group B. No significant statistically difference except IRBBB and PE incidence between the groups (P > 0.05) were shown. The followup data shows that all above problem were reduced and no other complication such as device dislocation or drop-off, thrombosis and obstruction of left or right ventricular outflow tract was found.
Conclusions The results show that occlusion procedure is comparable to traditional open heart surgery for treatment of subaortic ventricular septal defect in the selected patients. More experience and long-term follow-up are mandatory to assess safety and effectiveness of this procedure as an alternative to conventional surgery.