A comparative study of minimal lower-sternal incision device closure, minimal right thoracic incision device closure, and midsternal open repair of isolated perimembranous VSD, a retrospective cohort study

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Highlights

  • To compare transthoracic device closure via two different incisions and repair via midsternal incision for pmVSD.

  • All the three treatments can achieve satisfactory early clinical efficacy.

  • Both device approaches have the advantages of a quick recovery and good cosmetic appearance of the incision.

Abstract

Objective

To compare transthoracic device closure via a minimal lower-sternal incision or minimal right thoracic incision and surgical repair via midsternal incision for perimembranous ventricular septal defect (VSD).

Methods

We retrospectively analyzed the clinical data of 147 patients with isolated perimembranous VSD who were treated in our hospital from June 2017 to December 2017. According to the therapeutic approaches, the patients were divided into group A(transthoracic device closure via a minimal lower-sternal incision), group B((transthoracic device closure via a minimal right thoracic incision) and group C(surgical repair via midsternal incision). The clinical data of the three groups were statistically analyzed.

Results

The three groups of patients had satisfactory outcomes for VSD closure. No complications, including third-degree atrioventricular block, large residual shunt requiring re-operation, newly moderate-severe aortic or tricuspid regurgitation, occluder detachment were reported. Compared with group C, the operative time, duration of mechanical ventilation, length of ICU stay, drainage volume, blood transfusion volume, length of the incision, and length of postoperative hospital stay were significantly lower in the device groups (A and B).

Conclusion

Transthoracic device closure via a minimal lower-sternal incision or minimal right thoracic incision and surgical repair via midsternal incision are sufficiently safe procedures for the treatment of isolated perimembranous VSD and can achieve satisfactory early clinical efficacy. Both device approaches have the advantages of a quick recovery and good cosmetic appearance of the incision.

Introduction

Surgical repair via midsternal incision is a standard and effective procedure for the treatment of ventricular septal defect (VSD) [1,2]. However, this procedure has shortcomings, including the potential injury during cardiopulmonary bypass (CPB), hemodilution requiring transfusion, slow postoperative recovery, and a larger incision. Transcatheter device closure of VSD is another conventional treatment with good clinical results, which has no incision, but it is still associated some potential risks, such as an incidence of third-degree AVB, potential vascular injury, X-ray radiation exposure [3,4]. In recent years, transthoracic device closure of VSD has been widely used in clinical practice [[5], [6], [7], [8]]. This procedure has the following advantages: avoidance of CPB, cosmetic incisions, reduced blood loss, and a quick postoperative recovery. The commonly used approaches for this procedure include minimal lower-sternal incision and via the minimal right thoracic incision. These two approaches have their advantages and disadvantages. As far as we know, there were no comparative studies for isolated perimembranous VSD closure using transthoracic device closure via a minimal lower-sternal incision, or minimal right thoracic incision, or surgical repair via the midsternal incision. We retrospectively analyzed the clinical data and the follow-up data to summarize the characteristics of the different three therapeutic approaches which were conducted in our hospital.

Section snippets

Material and methods

The study was approved by the ethics committee of our university and strictly adhered to the tenets of the Declaration of Helsinki. All patients' guardians signed informed consent forms which contained the advantages and disadvantages of the different treatments.

Results

The three groups of patients had satisfactory outcomes for VSD closure. As shown in Table 1, no significant differences in preoperative data were found between the three groups. Table 2 shows that compared with group C, the operative time, duration of mechanical ventilation, length of ICU stay, drainage volume, blood transfusion volume, length of the incision, and length of postoperative hospital stay were significantly reduced in the device groups (A and B). No significant differences in

Discussion

VSD is one of the most common congenital heart diseases, and perimembranous VSD is the most common type [[9], [10], [11]]. Since Lillehei performed the first repair of VSD under direct vision in the world in 1954 [12], well-developed surgical techniques and improvements in postoperative monitoring, have contributed to the meager mortality rate and good efficacy of the current surgical repair methods. Surgical repair has a wide range of indications and a high success rate [13,14]. This

Conclusion

All three therapeutic procedures are safe and effective and can achieve satisfactory early clinical efficacy. Transthoracic device closure via a minimal lower-sternal incision or minimal right thoracic incision have the advantages of less trauma and a quick recovery and can provide a better cosmetic appearance of the healed incision for patients with isolated perimembranous VSD.

Disclosure of grant(s) or other funding

This research was sponsored by Chinese national and Fujian provincial key clinical specialty construction programs.

Declaration of competing interest

The authors declare that they have no competing interests.

Acknowledgments

We highly acknowledge the contribution by the participating doctors: Dao-zhong Chen, Feng Lin, Qi-min Wang, Zhong-yao Huang, Xiao-fu Dai, Xue-Shan Huang, Dong-shan Liao. Also, we wish to extend our gratitude to all the anesthesiologists and perfusionists in our department.

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    These authors contributed equally to this study and shared the first authorship.

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