Effectiveness of transthoracic minimally invasive device closure for perimembranous ventricular septal defects in proximity to the aortic valve.

BACKGROUND

Transthoracic minimally invasive device closure (TDC) via the transthoracic approach can be used to treat ventricular septal defect (VSD). However, studies investigating transthoracic closure in pediatric patients with perimembranous ventricular septal defects (PmVSDs) located close to the aortic valve and without preoperative aortic regurgitation (AR) are still lacking. The aim of this study was to compare the efficacy and safety of TDC and conventional surgical repair (CSR) for PmVSDs measuring ≤2 mm from the aortic valve in pediatric patients without preexisting AR.

METHODS

A retrospective cohort study involving 119 pediatric patients treated between March 2017 and April 2024, including 51 who underwent TDC and 68 who received CSR, was conducted. Baseline characteristics were balanced using inverse probability of treatment weighting (IPTW). Primary outcomes included operation time, duration of ventilator support, chest tube drainage volume, postoperative hospital length of stay, and complications at 6 months postprocedure.

RESULTS

The TDC group had significantly shorter operating times (70.95 vs. 146.59 minutes), shorter ventilation duration (97.12 vs. 219.98 minutes), less blood loss (30.54 vs. 115.15 mL), and shorter postoperative hospital stays (4.45 vs. 6.13 days; all P<0.001). The residual shunt (0% vs. 2.9%) and atrioventricular block (AVB) (0% vs. 5.9%) rates were lower in the TDC group, whereas new-onset mild valvular regurgitation occurred in 3.9% of TDC patients compared with 0% in the CSR group. Overall morbidity was 3.9% in the TDC group vs. 8.8% in the CSR group (P=0.46). No mortality or late reinterventions were observed during follow-up.

CONCLUSIONS

Transthoracic device closure under transesophageal echocardiography (TEE) guidance is a safe and effective alternative to CSR for selected cases of PmVSDs adjacent to the aortic valve, resulting in faster recovery and favorable short-term outcomes.