Matched Comparison Of Transvenous Versus Transthoracic Device Closure Of Ventricular Septal Defects

Objective: To compare the effectiveness, complications and hospitalization expenses of trans-venous device closure(TVDC) versus trans-thoracic device closure(TTDC) for ventricular septal defects(VSDs) after propensity score matching(PSM).Methods: 81 cases VSD patient who had undergone TVDC and 263 TTDC were retrospectively collected. PSM was conducted according to the age, weight and diameter of VSD. In 1:2 matching, 81 TVDC and 162 TTDC were matched. The baseline characteristics, intraoperative variables, examinations and follow-up data of each group were collected to compare the effectiveness, complications(including major and minor complications), expenses and hospital stay.Results:After 1:2 matching, the two groups had similar baseline, occluder size(6.25±1.93 mm vs 6.64±1.96 mm, p=0.139), procedure success rate(95.1% vs 97.5%, p=0.525) and major complication rate(0.0% vs 2.5%, p=0.304) with no death in each group. Minor complication is higher in TTDC group than TVDC group(61.7% vs 46.9%, p=0.028). During follow-up, the two groups had similar survival rate of freedom from major complications(Log-Rank test, p=0.127). The survival rate of freedom from minor complications is higher in TVDC group than TTDC group(Log-Rank test, p=0.004). Moreover, TVDC group has shorter hospital stay(7.53± 1.51 days vs 11.09±4.03 days, p<0.001), less expense(30,123.7±6,021.4 RMB vs 37,269.8±7,749.0 RMB, p=0.011) and lower general anesthesia(64.2% vs 100%, p<0.001).Conclusions:Both TVDC and TTDC are equally effective for closure of VSD. TVDC has less invasive, lower expense and faster recovery, should be the first choice for most patients with VSD.