Walavalkar Varsha, Maiya Shreesha, Pujar Suresh, Ramachandra Prakash, Siddaiah Satheesh, Spronck Bart, Vanagt Ward Y, Delhaas Tammo
Department of Pediatric Cardiology and Grown-Up Congenital Heart Diseases, Narayana Institute of Cardiac Sciences, NH Health City, 258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, Karnataka, 560099, India.
Department of Biomedical Engineering, School of Engineering & Applied Science, Yale University, New Haven, CT, USA.
Pediatr Cardiol. 2020 Mar;41(3):591-598. doi: 10.1007/s00246-020-02315-0. Epub 2020 Feb 13.
To identify suitable cases and reduce failure/complication rates for percutaneous ventricular septal defect (VSD) closure, we aimed to (1) study causes of device failure and (2) compare outcomes with different VSD types and devices in a high-volume single center with limited resources. Retrospective data of 412 elective percutaneous VSD closure of isolated congenital VSDs between 2003 and 2017 were analyzed. Out of 412, 363 were successfully implanted, in 30 device implantation failed, and in 19 the procedure was abandoned. Outcome was assessed using echocardiography, electrocardiography, and catheterization data (before procedure, immediately after and during follow-up). Logistic regression analyses were performed to assess effects of age, VSD type, and device type and size on procedural outcome. Median [interquartile range] age and body surface area were 6.6 [4.1-10.9] years and 0.7 [0.5-1.0] m, respectively. Device failure was not associated with age (p = 0.08), type of VSD (p = 0.5), device type (p = 0.2), or device size (p = 0.1). Device failure occurred in 7.6% of patients. As device type is not related to failure rate and device failure and complication risk was not associated with age, it is justifiable to use financially beneficial ductal devices in VSD position and to consider closure of VSD with device in clinically indicated children.
为了识别合适的病例并降低经皮室间隔缺损（VSD）封堵术的失败/并发症发生率，我们旨在：（1）研究器械失败的原因；（2）在资源有限的高容量单中心比较不同VSD类型和器械的治疗结果。分析了2003年至2017年间412例孤立性先天性VSD择期经皮VSD封堵术的回顾性数据。412例中，363例成功植入，30例器械植入失败，19例手术放弃。使用超声心动图、心电图和导管检查数据（术前、术后即刻和随访期间）评估治疗结果。进行逻辑回归分析以评估年龄、VSD类型、器械类型和尺寸对手术结果的影响。年龄[四分位间距]中位数和体表面积分别为6.6[4.1 - 10.9]岁和0.7[0.5 - 1.0]m²。器械失败与年龄（p = 0.08）、VSD类型（p = 0.5）、器械类型（p = 0.2）或器械尺寸（p = 0.1）无关。7.6%的患者发生器械失败。由于器械类型与失败率无关，且器械失败和并发症风险与年龄无关，因此在VSD位置使用经济实惠的导管类器械以及在临床指征明确的儿童中考虑使用器械封堵VSD是合理的。
