title: Transfemoral and perventricular device occlusions and surgical repair for doubly committed subarterial ventricular septal defects.
abstract: BACKGROUND
  Transfemoral and perventricular device occlusions are performed for doubly committed subarterial ventricular septal defect (dcVSD) to reduce the invasiveness of the conventional surgical repair through a median sternotomy. Few comparative studies have been conducted of these three procedures.
  
  
  METHODS
  Inpatients with isolated dcVSD who had undergone transfemoral and perventricular device occlusions or conventional surgical repair from January 2009 to June 2013 were reviewed to compare the three procedures.
  
  
  RESULTS
  Procedure success was achieved in 33 transfemoral (66%), in 74 perventricular (94.9%), and in 205 repair (97.6%) procedures. The transfemoral group had the lowest success rate (p < 0.001), whereas the perventricular and repair groups had similar success rates (p = 0.418). Transfemoral patients were the oldest (p < 0.001) and had a dcVSD size similar to that of patients in other two groups (p = 0.518). The repair group required the longest hospitalization and longest stays in the intensive care unit (p < 0.001), required the longest operating room and mechanical ventilation times (p < 0.001), and had the highest rate of transfusion (p < 0.001). Major adverse events occurred in one transfemoral (3%), in two perventricular (2.7%), and in three repair (1.4%) procedures. Minor adverse events were absent in transfemoral (0%) and occurred in three perventricular (4%) and 14 repair (6.7%) procedures. No significant difference was noted in the rates of adverse events the three groups (p = 0.569). No grade 3 valvular regurgitation or complete atrioventricular block was observed in the studied patients.
  
  
  CONCLUSIONS
  Device occlusion may be an alternative to surgical repair in selected patients with dcVSD. Perventricular occlusion was the preferred approach because it showed a higher success rate than transfemoral occlusion.
authors.affiliation: Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Zhao Yang
authors.affiliation: Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.
authors.forename: Cao
authors.initials: C
authors.lastname: Hua
authors.affiliation: Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Ma
authors.initials: M
authors.lastname: Yuan Ji
authors.affiliation: Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Qiang
authors.affiliation: Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Pan
authors.initials: P
authors.lastname: Wen Zhi
authors.affiliation: Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Wan Hua
authors.affiliation: Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China.
authors.forename: Xiong
authors.initials: X
authors.lastname: Chang
authors.affiliation: Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China.
authors.forename: Fan
authors.initials: F
authors.lastname: Lin
authors.affiliation: Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Liang-Long
authors.affiliation: Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: gejunbo888@126.com.
authors.forename: Ge
authors.initials: G
authors.lastname: Jun Bo
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005263:Femoral Artery; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000601:surgery*; D006352:Heart Ventricles; D006801:Humans; D007902:Length of Stay; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D055989:Septal Occluder Device; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult