Device closure of ventricular septal defects by hybrid procedures: a multicenter retrospective study.
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.
Department of Pediatric Cardiology, Pediatric Heart Center, Giessen, Germany. ina.michel-behnke@meduniwien.ac.at
Ina
I
Michel-Behnke
Peter
P
Ewert
Andreas
A
Koch
Harald
H
Bertram
Mathias
M
Emmel
Gunther
G
Fischer
Roland
R
Gitter
Rainer
R
Kozlik-Feldman
Reinald
R
Motz
Erwin
E
Kitzmüller
Oliver
O
Kretschmar
D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002315:Cardiopulmonary Bypass; D002675:Child, Preschool; D020878:Device Removal; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005060:Europe; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018579:Patient Selection; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome