Analysis Of Early Complications And Risk Factors After Transcatheter Closure In 972 Children With Ventricular Septal Defect

Objective: To analyze the risk factors of early complications after transcatheter closure of membranous ventricular septal defect(mVSD).Methods: A retrospective analysis of the clinical data of children with mVSD using percutaneous catheterization in Children's Hospital of Chongqing Medical University from 2009 to 2019 was performed and early complications were analyzed.Univariate analysis and multivariate logistic regression analysis were used to summarize the risk factors of early postoperative complications.Results: 972 cases of mVSDs were collected,of whom 487(50.1%)patients were male.The median age was 3.17(2.50,4.67)y,the median weight was 14.50(12.00,17.00)kg,the median VSD size was 3.50(2.80,4.50)mm,and the median occluder size was 6.00(5.00,7.00)mm.66(6.79%)patients used eccentric occluders,897 patients used symmetric occluders,and 9(0.93%)patients used small waist large side occluders.New arrhythmia was found in 20.27%(197/972),conduction block was found in 14.20%(138/972),abnormal origin arrhythmia was found in7.00%(68/972),complete right bundle branch block+left anterior fascicular block(CRBBB+ LAFB)was found in 0.31%(3/972),complete left bundlebranch block(CLBBB)was found in 0.10%(1/972),?°atrioventricular block(AVB)was found in 0.10%(1/972),?°AVB was found in 0.31%(3/972);new valve regurgitation was found in 24.18%(235/972),aortic insufficiency(AI)was found in 20.06%(195/972),moderate-severe tricuspid insufficiency(TI)was found in 0.41%(4/972),severe TI was found in 0.21%(2/972);residual shunt was found in 10.80%(105/972),severe residual shunt was found in 0.21%(2/972),hemolysis was found in0.31%(3/972),pseudoaneurysms was found in 1.23%(12/972),thrombosis was found in 0.10%(1/972),occluder translocation was found in 0.10%(1/972).The protective factor of new arrhythmia was left ventricular systolic blood pressure(OR = 0.965,95% CI = 0.951~0.980,P=0.000),and the independent risk factors were aneurysm(OR = 2.957,95% CI = 2.108~ 4.147,P = 0.000),right ventricular systolic blood pressure(OR = 1.026,95% CI = 1.005 ~ 1.047,P = 0.014),size of mVSD(OR = 1.194,95% CI =1.075 ~ 1.327,P = 0.001);The protective factor of new valve regurgitation was age(OR= 0.888,95% CI = 0.823 ~ 0.957,P = 0.002),and independent risk factors were formation of aneurysm(OR = 1.654,95% CI = 1.192 ~2.297,P = 0.003),asymmetric occluder(OR = 2.607,95% CI = 1.529 ~4.444,P = 0.000);the independent risk factors of residual shunt were mVSD with noncoronary cusp prolapse(OR = 2.067).,95% CI = 1.105 ~3.868,P = 0.023),aneurysm(OR = 2.903,95% CI = 1.875 ~ 4.495,P =0.000),size of VSD(OR = 1.154,95% CI = 1.018)~ 1.310,P = 0.026),size of occluder(OR = 1.234,95% CI = 1.080 ~ 1.410,P = 0.002).Conclusion: Left ventricular systolic pressure,right ventricular systolic pressure,size of mVSD,aneurysm,age,asymmetric occluder,mVSD with noncoronary cusp prolapse,size of occluder are related with the early complications of mVSD.