title: Minimally invasive transthoracic device closure of isolated ventricular septal defects without cardiopulmonary bypass: long-term follow-up results.
abstract: OBJECTIVE
  Minimally invasive transthoracic device closure (MITDC) of ventricular septal defects (VSD) under transesophageal echocardiography guidance is increasingly and successfully being performed with excellent results. We retrospectively reviewed 458 patients who received this treatment in our center and summarized the 6-year follow-up results.
  
  
  METHODS
  From March 2007 to March 2013, 458 patients (mean age, 11.41 ± 6.73 months; body weight, 9.82 ± 5.88 kg) underwent MITDC. Patients were strictly followed up according to a standard protocol by 2 specially appointed doctors. Meanwhile, 283 cases with an isolated VSD who underwent traditional surgical repair during this period were also reviewed and several characteristics were compared between the 2 groups.
  
  
  RESULTS
  A total of 441 cases were successfully closed (96.29%), and the other 17 patients were converted to surgical closure. There were no deaths or major complications. Concentric devices were used in 313 cases (70.98%), eccentric devices in 113 cases (25.62%), and special devices in 15 cases (3.40%). The mean intracardiac deployment time was 18.35 ± 17.13 minutes (3-48 minutes). Most of the patients were discharged within 5 days after surgery. Follow-up in 426 patients (96.60%) ranged from 6 to 78 months (47.31 ± 19.69 months) and revealed no severe complications. Fewer minor complications, such as device-related trace to mild tricuspid regurgitation, residual shunt, and right bundle branch block, occurred with MITDC than surgical closure.
  
  
  CONCLUSIONS
  MITDC of a VSD on a beating heart is a safe and effective alternative to conventional treatments. The 6-year clinical outcomes are promising. Modification of occluders and the delivery set play an important role in good outcomes.
authors.affiliation: Division of Cardiothoracic Surgery, Heart Center, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China. Electronic address: xingqs0532@126.com.
authors.forename: Quansheng
authors.initials: Q
authors.lastname: Xing
authors.affiliation: Division of Cardiothoracic Surgery, Heart Center, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Division of Cardiology, Heart Center, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Shi
authors.affiliation: Department of Epidemiology, No.1 Clinical Medical College, Chongqing Medical University, Chongqing, China.
authors.forename: Yuhan
authors.initials: Y
authors.lastname: Xing
authors.affiliation: Division of Cardiology, Heart Center, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China.
authors.forename: Guiling
authors.initials: G
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult