Comparison Of Off-pump Periventricular Device Closure (OPPDC) And Conventional Cardiopulmonary Bypass Repair (CCBR) In Perimembranous Ventricular Septal Defect(VSD) On The Inflammatory Response

ObjectivesOff-pump periventricular device closure (OPPDC) has been developed tobe a safe, less complex, feasible and effective choice for selectedperimembranous ventricular septal defect (VSD) patients. This study comparesthe effects of off-pump periventricular device closure (OPPDC) andconventional cardiopulmonary bypass repair (CCBR) in perimembranousventricular septal defect (VSD) on the inflammatory response that aims toevaluate OPPDC more objectively.MethodsAll perimembranous VSD patients of this project were cured in Linyi people’shospital. This trial is a non-randomized control trial that the patients weregrouped into two groups(OPPDC group and CCBR group) by the patients’willingness and surgical indications. Transthoracic echocardiography andphysical examination was used to confirm the diagnosis of perimembranousVSD in these patients and to assess the circumferential defect margin for closure.All the patients were deemed to have surgical indications for OPPDC and to nothave other coexisting cardiac anomalies, severe pulmonary hypertension, activeinfectious disease or diseases of other organs.15patients were selectedrespectively from the OPPDC and CCBR group. The inflammatory responsewere assessed by measuring serum interleukin-6(IL-6), interleukin-8(IL-8) andtumor necrosis factor-alpha (TNF-α) preoperatively, and at2,6,24, and48 hours postoperatively. Meanwhile, postoperative clinical variables between thegroups were also recorded.ResultAll patients were treated successfully. The postoperative increase in the levelsof IL-6, IL-8and TNF-α was significantly lower in OPPDC group compared toCCBR group(p<0.01). Postoperative IL-6, IL-8and TNF-α levels of CCBRgroup was significantly higher compared to the preoperative index(p<0.01),while there was no significant difference in the OPPDC group betweenpreoperative and postoperative index (p>0.01). In addition, patients in OPPDCgroup had significantly better performance on clinical variables (surgicalincision, operative time, ICU stay, hospital stay and drainage volume) thanpatients in CCBR group.ConclusionThe IL-6, IL-8and TNF-α levels after surgery are significantly different inOPPDC and CCBR groups. The off-pump periventricular device closure leads toa lower degree of the inflammatory response compared with the conventionalcardiopulmonary bypass repair. OPPDC is a safe, less complex, feasible andeffective choice for selected perimembranous ventricular septal defect (VSD)patients.