Perventricular device closure of perimembranous ventricular septal defect: effectiveness of symmetric and asymmetric occluders
Perventricular device closure of perimembranous ventricular septal defect: effectiveness of symmetric and asymmetric occluders
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DOI：
10.1093/ejcts/ezw352
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发表时间：
2017-03-01
影响因子：
3.4
通讯作者：
Pan, Xiang-Bin
中科院分区：
文献类型：
--
作者：
Ou-Yang, Wen-Bin;Wang, Shou-Zheng;Pan, Xiang-Bin
目的：评价对称封堵器和非对称封堵器在膜周室间隔缺损（pmVSDs）无体外循环的经室装置闭合中的安全性和有效性。方法：本回顾性研究纳入2011年5月至2016年4月581例经食管超声心动图指导下经室装置关闭pmvsd的患者，并在1、3、6和12个月以及此后每年进行门诊心电图和经胸超声心动图评估。结果：器械植入总成功率92.6%（即刻手术43例）。对称型（n = 353）和非对称型（n = 185）患者在年龄、体重和缺损直径分布上无显著差异；然而，在出院前和平均28.6 +/- 21.2（范围，1-60）个月的随访中，对称组有较低的轻微残余分流率（5.7% vs 11.4%, P = 0.018; 0.8% vs 5.9%, P = 0.001）和束支阻滞率（0.8% vs 5.4%, P = 0.002; 0.6% vs 3.8%, P = 0.009）；随访时，不对称组的残余分流率（47.6% vs 85.0%, P = 0.020）和相似分支阻滞消失率（30.0% vs 33.3%, P = 1.000）较低。没有严重的并发症，如主动脉反流，恶性心律失常，溶血或装置脱位。结论：采用对称和非对称封堵器对pmvsd进行经室装置封闭是安全有效的。然而，对于不对称闭塞者来说，较低的残余分流消失率和较高的分支阻塞发生率有利于术中出现残余分流时更主动地立即转换为手术修复。
OBJECTIVES: To assess safety and effectiveness of symmetric and asymmetric occluders in perventricular device closure without cardiopulmonary bypass of perimembranous ventricular septal defects (pmVSDs).METHODS: The present retrospective study enrolled 581 patients who underwent perventricular device closure of pmVSDs under transoesophageal echocardiography guidance from May 2011 to April 2016, and outpatient electrocardiography and transthoracic echocardiography assessments at 1, 3, 6 and 12 months, and yearly thereafter.RESULTS: The overall success rate of device implantation was 92.6% (43 surgical conversions immediately). Between patients receiving symmetric (n = 353) and asymmetric (n = 185) occluders, there were no significant differences in age, weight and defect diameter distributions; however, both before discharge and at mean 28.6 +/- 21.2 (range, 1-60)-month follow-up, the symmetric group had lower rates of trivial residual shunt (5.7% vs 11.4%, P = 0.018; and 0.8% vs 5.9%, P = 0.001) and bundle branch block (0.8% vs 5.4%, P = 0.002; and 0.6% vs 3.8%, P = 0.009); and at follow-up, the asymmetric group had lower residual shunt (47.6% vs 85.0%, P = 0.020) and similar branch block (30.0% vs 33.3%, P = 1.000) disappearance rates. There were no severe complications, i. e. aortic regurgitation, malignant arrhythmias, haemolysis or device dislocation.CONCLUSIONS: Perventricular device closure of pmVSDs appears safe and effective with symmetric and asymmetric occluders. However, the lower residual shunt disappearance and higher branch block incidence rates for asymmetric occluders would favour more proactive conversion to surgical repair immediately when residual shunt is present intraoperatively.