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Device closure of ventricular septal defects by hybrid procedures: A multicenter retrospective study
Author(s) -
MichelBehnke Ina,
Ewert Peter,
Koch Andreas,
Bertram Harald,
Emmel Mathias,
Fischer Gunther,
Gitter Roland,
KozlikFeldman Rainer,
Motz Reinald,
Kitzmüller Erwin,
Kretschmar Oliver
Publication year - 2011
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.22666
Subject(s) - medicine , pericardial effusion , percutaneous , heart septal defect , shunt (medical) , cardiology , surgery
Objective : This study reports on the feasibility, efficacy, and outcome of hybrid procedures to close ventricular septal defects (VSD), reflecting the experience of 11 centers in Germany, Austria, and Switzerland. Background : Beating heart closure of VSD has attracted interest in small infants, complex anomalies and postinfarction scenarios where patients are at high risk during surgery. Perventricular or intraoperative device placement allows access to the lesions where percutaneous delivery is limited. Methods : Between December 2001 and April 2009, placement of Amplatzer septal occluders was attempted in 26 patients. The defects were located in the perimembranous ( n = 5) and muscular septum ( n = 21). In 20 patients, a perventricular approach was used, and, in six, the occluders were placed under direct visualization being part of a complex heart surgery. Results : In 23 of 26 procedures, device placement was successful (88.5%). The mean defect size was 7.8 mm (range, 3.5–20). The occluder types were perimembranous VSD occluder ( n = 4), muscular VSD occluder ( n = 20), postinfarct VSD occluder ( n = 1), and ASD occluder ( n = 1) with a ratio device/defect of 0.9–2.4 (median 1.15). Device removal was necessary in three due to arrhythmia, malpositioning, and additional defects. Pericardial effusion occurred once. In the remaining 22 patients, there were no procedure or device‐related complications. During mean follow up of 1.4 years (range, 1 day–3.9 years), a residual shunt that was more than trivial was observed in one patient out of 21 successful procedures. Conclusions : Perventricular and intraoperative device closure of VSD is as effective as a surgical patch and averts the increased morbidity of conventional surgical repair in a subgroup of high‐risk patients. © 2010 Wiley‐Liss, Inc.