Single Center Transcatheter Device Occlusion of Ventricular Septal Defects via Percutaneous and Open Sternotomy Approach

Naimi, Iman

Background
Given availability of smaller devices, more patients are now undergoing ventricular septal defect (VSD) device closure, either by percutaneous (PC) or open sternotomy perventricular (PV) approaches. At Seattle Children’s Hospital (SCH), we have been performing transcatheter (TC) VSD closure for nearly two decades and set forth to analyze our center’s experience and success rate.

Methods
Patients who had undergone device occlusion of VSD via PC or PV approaches from April 2001 to November 2018 at SCH were included.

Results
45 patients underwent 46 interventions. 2 patients did not have long term outcome data and 1 died during observational time frame and were excluded from long term analysis. Cohort 1 had 34 patients who underwent 35 PC VSD closures. 11 patients in cohort 2 underwent PV VSD closure with median age of 4.3 yrs (range: 0.38-23 yrs) and 0.65 yrs (range: 0.19-1.4 yrs), respectively. The median weight for Cohort 1 was 14.7 kg (range: 6-81.2 kg) versus 6.1 kg (range: 2.5-8.3 kg) for cohort 2. The PC group had a total of 41 devices placed versus the 11 devices in PV group. A total of 52 defects were closed using Amplatzer mVSD (41), Amplatzer Duct Occluder II (7), Amplatzer Vascular Plug II (2), and Amplatzer Ductal Occluder I (2). Overall procedural success was 96% with 98% overall survival to discharge. PC success was achieved in 94% and 100% in PV group. Survival to discharge in the PC cohort was 100% and 91% in the PV cohort. Overall transplant free survival at 30 months was 95% (41/43). Combined cohort re-intervention rate 7% (3/43). Surgical re-intervention was performed in 2 patients (5%). Median follow-up for PC group was 2.3 years (range: 0.05 – 17.4 yrs) and for PV group was 5.8 yrs (range: 0.02-17.4 yrs). The PC cohort had a median LOS of 1 day whereas the PV cohort had a median LOS of 6 days (range: 2-47 days).

Conclusions
There is a tendency to use PV technique for smaller and younger patients which brings about a longer LOS. There is a high procedural success rate with excellent survival to discharge using either approach. Although the LOS was greater for patients undergoing PV closure (6 days), this is less than age, weight and diagnosis matched patients (n=299) undergoing standard surgical closure (11 days).