| Objective: To evaluate the efficacy and safety of transcatheter and open-heart surgery techniques in children with ventricular septal defect(VSD).Methods: The clinical data of patients diagnosed with isolated VSD from affiliated Children's Hospital of Chongqing Medical University from January,2014 to January,2019 were retrospectively studied.The patients were divided into transcatheter group and surgical group.The preoperative data,success rate of occlusion,postoperative complications and outcomes were compared.Results: In total 875 patients were enrolled in this study.559 patients underwent transcatheter closure,including 297 males and 262 females.The mean age was 3.75±2.27 years,the mean body weight was 15.39±5.62 kg,the mean VSD diameter on echocardiography was 5.96±2.10 mm,and the mean cardiothoracic ratio was 0.54±0.04.316 patients underwent open-heart surgery,including 187 males and 129 females.The mean age was 2.62±2.28 years,the mean body weight was 12.25±5.40 kg,the mean VSD diameter on echocardiography was 8.14±3.01 mm,and the mean cardiothoracic ratio was 0.56±0.05.In the transcatheter group,successful occlusion was achieved in 556 cases(99.46%),except for 1 case of early postoperative third-degree atrioventricular block(?° AVB),1 case of severe aortic regurgitation,and 1 case of severe tricuspid regurgitation.The success rate of occlusion in surgical group was 100%.2 cases of ?° AVB occurred during the operation,and the temporary pacemaker was implanted immediately.There was no significant difference between the success rate of the two groups(P > 0.05).The mean duration of the operation was 44.01 ±18.24 minutes for the transcatheter group and 137.73±28.83 minutes for the surgical group.The mean hospital stay was 7.34±1.45 days for the transcatheter group and 16.50±4.65 days for the surgical group.92 cases(29.11%)in surgical group received intraoperative blood transfusion while None of the patients in the transcatheter group required blood transfusion.Postoperative PICU monitoring was performed in 2 cases for the transcatheter group(0.36%)and 40 cases for the surgical group(12.66%).The operation duration,median PICU stay,median hospital stay and the incidence of blood transfusion was significantly lower in the transcatheter group(P<0.001).Echocardiography examinations of before and 24 hours after the operation were compared.In the transcatheter group before operation,the left ventricular ejection fraction(LVEF),the left ventricular fractional shortening rate(LVFS),the left ventricular end-diastolic dimension(LVEDD)and the left ventricular end-systolic dimension(LVESD)were 66.78±4.94 %,36.28 ±3.94 %,35.72±3.64 mm and 22.68 ±2.77 mm.At 24 hours after operation,they were 66.72±5.09 %,36.23±4.02 %,34.89±3.59 mm and 22.20±2.61 mm.The statistical analysis demonstrated that there were no significant differences(P>0.05)in LVEF and LVFS,but LVEDD and LVESD were found significantly lower after operation(P<0.001).In the surgical group before operation,the LVEF,the LVFS,the LVEDD and the LVESD were 67.45±5.45 %,36.83±4.33 %,35.09±5.04 mm and 22.28±3.52 mm.At 24 hours after operation,they were 63.95±8.07 %,33.74±5.46 %,30.18±4.13 mm and 19.66±3.19 mm.The statistical analysis demonstrated,the LVEF,LVFS,LVEDD and LVESD were significantly lower after operation(P < 0.001).There was no significant difference in LVEF,LVFS,LVEDD and LVESD before operation between the transcatheter group and the surgical group.24 hours after operation,the LVEF,LVFS,LVEDD and LVESD in transcatheter group were significantly lower than those in surgical group(P<0.001).During the follow-up from 1 month to 24 months,there were no significant differences in LVEF and LVFS(P>0.05)of the both two groups,while LVEDD and LVESD were significantly lower than those before operation(P<0.001).The total incidence of major complications in the transcatheter group and surgical group were 0.54% and 0.63%.There was no significant difference in the incidence of major complications between the two groups(P>0.05)in early follow up.The total incidence of minor complications was 20.39%(114 cases)and 41.46%(131cases).The incidence of minor complications in the surgical group was significantly higher than that in the transcatheter group(P<0.05).In the transcatheter group,a periprosthetic residual shunt was present in 66 patients(11.81%)at 24 hours after the operation.New moderate aortic regurgitation was present in 1 case(0.18%).New moderate tricuspid regurgitation was present in 3 cases(0.54%).Right bundle branch block(RBBB)was present in 28 cases(5.01%).Left bundle branch block(LBBB)was present in 13 cases(2.33%).Double bundle branch block was present in 3 cases(0.54%).?-?° AVB was present in 3 cases(0.72%).In the surgical group,a periprosthetic residual shunt was present in 55 cases(17.41%).RBBB was present in 75 cases(23.73%).Double bundle branch block was present in 8 cases(2.53%).?-?° AVB was present in 17 cases(5.38%).The early postoperative conduction block and residual shunt disappeared during the follow up in most cases.In the transcatheter group,there were 6 new cases of RBBB,4 new cases of LBBB,1 new case of double bundle branch block and 3 new cases of ?° AVB.2 cases of RBBB and 2 cases of LBBB progressed to double bundle branch block,but none was found in ?° AVB.In the surgical group,there were 4 new cases of RBBB and 1 new case of ?° AVB.1 case of RBBB progressed to double bundle branch block.1 case of ?° AVB progressed to ?° AVB and implanted permanent pacemaker.Conclusions: Transcatheter and open-heart surgery are both effective for VSD treatment in children,and the medium-term effect is promising.Transcatheter closure has advantages in shorter operation duration and hospital stay,lower incidence of blood transfusion and minor complications.Therefore,transcatheter closure should be the better choice for children with VSD when there was no contraindication. |
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