title: Minimally invasive perventricular device closure of doubly committed sub-arterial ventricular septal defects: single center long-term follow-up results.
abstract: BACKGROUND
  To evaluate the long-term safety and efficacy of using perventricular device closure in treating selected patient with doubly committed sub-arterial ventricular septal defect (VSD) METHODS: During July 2007 and April 2011, 86 patients with doubly committed subarterial VSD who met the inclusion criteria were enrolled in this study. Perventricular closure was attempted using a unique design eccentric device under the guidance of transesophageal echocardiography. Complications such as residual shunt, arrhythmia, valve regurgitation were all recorded in postoperative period and during follow-up. Multiple logistic regression analysis was performed to study risk factors for procedure failure and complications.
  
  
  RESULTS
  Perventricular device closure was successfully done in 75 patients (87.2 %) with mean age 7.0 ± 7.0 years old, VSD size 4.8 ± 1.5 mm and device size 6.7 ± 1.7 mm. Complete closure rate was achieved in 94.7 % at discharge and 96 % during follow-up. No severe complications such as device embolism, significant arrhythmia, left ventricular outflow tract obstruction as well as obvious valve regurgitation were noted during follow-up (Mean 4.5 ± 1.5 years). Procedure induced trivial-mild grade aortic valve regurgitation (AR) was noted in 16 (21.3 %) patients at discharge while 8 of them resolved during follow-up. Multivariable analysis revealed that procedure-induced AR was associated device diameter to patients' weight (OR=12.3 95 % CI 1.5- 99.2). Perventricular device closure was failed in 11 patients, preoperative aortic valve prolapse was the major risk factor for failure of the procedure (OR=65 95 % CI 7.5- 564.1).
  
  
  CONCLUSIONS
  Perventricular closure of doubly committed subarterial VSDs appears to be a safe and effective minimally invasive treatment option in selected patients with good long-term outcomes.
  
  
  BACKGROUND
  Unique Identifier: ChiCTR-TNC-00000203 .
authors.affiliation: Pediatric Heart Center and Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China. zos88@vip.sohu.com.
authors.forename: Shu
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Pediatric Heart Center and Department of Cardiovascular Surgery, West China hospital, Sichuan University, Chengdu, Sichuan, 610041, China. 250794259@qq.com.
authors.forename: Da
authors.initials: D
authors.lastname: Zhu
authors.affiliation: Pediatric Heart Center and Department of Cardiovascular Surgery, West China hospital, Sichuan University, Chengdu, Sichuan, 610041, China. enforest@qq.com.
authors.forename: Qi
authors.initials: Q
authors.lastname: An
authors.affiliation: Pediatric Heart Center and Department of Cardiology, West China hospital, Sichuan University, Chengdu, China. hxyyth@gmail.com.
authors.forename: Hong
authors.initials: H
authors.lastname: Tang
authors.affiliation: Pediatric Heart Center and Department of Cardiovascular Surgery, West China hospital, Sichuan University, Chengdu, Sichuan, 610041, China. yangjian1533@qq.com.
authors.forename: Dajiang
authors.initials: D
authors.lastname: Li
authors.affiliation: Pediatric Heart Center and Department of Cardiovascular Surgery, West China hospital, Sichuan University, Chengdu, Sichuan, 610041, China. edidian@163.com.
authors.forename: Ke
authors.initials: K
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D015999:Multivariate Analysis; D019919:Prosthesis Implantation / Q000379:methods; D055989:Septal Occluder Device; D016896:Treatment Outcome; D055815:Young Adult