Comparative study of two minimally invasive approaches for ventricular septal defect

  AIM  To compare and analyze the advantages and disadvantages of percutaneous closure and minimally invasive transthoracic device closure in congenital ventricular septal defect.

  METHODS  A retrospective review of 168 patients who underwent percutaneous closure and minimally invasive transthoracic device closure in the Department of Cardiovascular Surgery of General Hospital of Ningxia Medical University from January 2012 to June 2019. According to the different approaches, 88 were occluded by percutaneous closure group (PC group), and 80 were occluded by minimally invasive transthoracic device group (MITDC group). Following up and collectting terms of age, weight, type of defect, defect diameter, surgical method, occluder diameter, operation time, occlusion success rate, postoperative complications, length of stay in hospital, and cost of hospitalization. Statistical analysis was performed using SPSS 23.

  RESULTS  In 88 ventricular septal defects of PC group, 83 were successfully occluded, with a success rate of 94.32%. In 80 ventricular septal defects of MITDC group, 74 were successfully occluded , with success rate of 92.50%. There was no significant difference in the success rate between the two groups. Compared with the PC group,the MITDC group had younger age (13±14) years vs (8±13) years, lighter-weight (33±20) kg vs (22±19) kg, and longer operation time (1.4±0.7) h vs (1.6±0.8) h, larger defect diameter (5.2±2.6）mm vs (4.2±1.8) mm), smaller occluder diameter (7.6±3.1) mm vs (6.0±2.3) mm, longer hospital stay (8.3±2.9) d vs (10.6±3.8) d and higher hospitalization costs (26126±5044) yuan vs (28322±5946) yuan and other differences are statistically significant (P < 0.05 or P<0.01); There was no significant difference in the type of defect between the two groups, but there are more types of VSD in the MITDC group than PC group. There was a significant difference in the amount of postoperative pericardial effusion between the two groups (P < 0.05).

  CONCLUSION  Both of minimally invasive approaches are safe and effective. Clinically, percutaneous closure is the first choice of patients with common types of ventricular defects. Patients such as infant or light-weight ones, or special types of ventricular defects are beneficial from transthoracic device closure.