title: Results of comparing transthoracic device closure and surgical repair with right infra-axillary thoracotomy for perimembranous ventricular septal defects.
abstract: OBJECTIVE
  Transthoracic device closure (TTDC) and surgical repair with right infra-axillary thoracotomy (SRRIAT) are two main alternative minimally invasive approaches for restrictive perimembranous ventricular septal defect (VSD); however, few studies have compared them with each other in terms of effectiveness and cost.
  
  
  METHODS
  Patients with perimembranous VSD undergoing TTDC or SRRIAT from January 2012 to July 2013 were reviewed in a comparative investigation between the two procedures.
  
  
  RESULTS
  Success from the procedures was achieved in 30 TTDC (30/33, 91%) and 96 SRRIAT patients (100%). Operation duration in the TTDC group was significantly shorter than that of the SRRIAT group (115.8 ± 43.8 vs 175.6 ± 41.3 min, P < 0.01). The total perioperative drainage, use of red blood cells, mechanical ventilation time, stay in the intensive care unit and hospital stay for the TTDC group were significantly less than those in the SRRIAT group. No deaths or complete atrioventricular block occurred in either group. One SRRIAT patient accepted a second surgery for residual shunt. TTDC costs slightly more than SRRIAT (40270.6 ± 2741.3 renmingbi [RMB] vs 32964.5 ± 8221.6 RMB, P < 0.01).
  
  
  CONCLUSIONS
  Both TTDC and SRRIAT showed excellent outcomes and cosmetic appearance for suitable VSD candidates. Although its costs were higher, TTDC had the advantages over SRRIAT of a short operation duration and intensive care unit stay and fewer days in the hospital.
authors.affiliation: Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Yijie
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Zhiping
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Jianming
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Fuping
authors.initials: F
authors.lastname: Li
authors.affiliation: Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Shen
authors.affiliation: Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Song
authors.affiliation: Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Shulin
authors.initials: S
authors.lastname: Zhao
authors.affiliation: Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Caijing
authors.initials: C
authors.lastname: Peng
authors.affiliation: Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Mingxiang
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Cardiovascular Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China zhongqianjin@qq.com zhongqianjin@gmail.com.
authors.forename: Qianjin
authors.initials: Q
authors.lastname: Zhong
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004322:Drainage; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D017707:Erythrocyte Transfusion; D005260:Female; D017048:Health Care Costs; D006345:Heart Septal Defects, Ventricular / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D055989:Septal Occluder Device / Q000191:economics; D013908:Thoracotomy / Q000009:adverse effects / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome
keywords: Minimally invasive cardiac surgery; Right infra-axillary thoracotomy; Transthoracic device closure; Ventricular septal defect