SAFETY AND EFFICACY OF TRANSCATHETER VERSUS SURGICAL CLOSURE OF VENTRICULAR SEPTAL DEFECTS IN CHILDREN

Hemida, Mohamed Sayed; El Keiy, Mohsen Taha; El Sisi, Amal Mahmoud; Abdelaziz, Doaa Mohamed; Abdelsamei Fadl, Ahmed

doi:10.21608/azjp.2018.70306

SAFETY AND EFFICACY OF TRANSCATHETER VERSUS SURGICAL CLOSURE OF VENTRICULAR SEPTAL DEFECTS IN CHILDREN

Document Type : Original Article

Authors

10.21608/azjp.2018.70306

Abstract

Background: While surgical repair of VSDs has been successful over 60 years, operative and late complications still occur and there are inherent risks associated with sternotomy and exposure to cardiopulmonary bypass . A desire to avoid these risks as well as the successful application of catheter –based device closure has led to an interest in developing a less invasive means by which to close VSDs. Objectives: To evaluate the safety and efficacy of trans-catheter versus surgical approach to correct VSD in a prospective comparative study. Patients and Methods: we performed this 2 years prospective observational study of 30 patients with VSD who were referred to Pediatric Cardiology Division of Cairo University and Al-Azhar university Pediatric Hospital to do either surgical or transcatheter VSD closure between 01/07/2014 to 01/07/2016 . After clinical and TTE examination we revised the criteria of the case upon which the decision was taken to close the VSD (surgery is indicated in patients with uncontrolled congestive heart failure symptoms, evidence of increased pulmonary vascular resistance or the development of aortic valve insuffiency secondary to leaflet prolapse). Their age ranged from 6 months to 18 years, weights from 6 Kg to 60 Kg and heights ranged from 60 to 160 cm. Results: In our study, success rate of trans-catheter and surgical closure was 100 %, The mean age of our prospective study was 3.01± 2.9 and 4.1± 2 years in surgery and cathter groups repectively , their body surface area was 0.4 ± 0.18 m2 and 0.6 ± 0.2 m2 in surgery and catheter groups respectively, the most common clinical presentations were, recurrent chest infection in 15(100%) vs. 13(86.7%) cases in surgery and catheter groups respectively, there were statistically significant difference between surgery and catheter before closure regarding LA/AO ratio (1.43 ±0.423 vs 1.17± 0.212 ) ,LVEDD (3.82+.608 vs 3.17+.704 respectively) and LVEDD Z-Score (2.61+1.16 vs 1.5+1.39 respectively ), no mortality , stroke nor neurological deficit was observed ,no major adverse events were occurred in the trans-catheter group, only 1major event was observed in the surgical group ( complete AV block postoperative , that needed pacemaker) ,the average hospital stay in surgical group 5.40+1.12 days vs 1.13+.35 days in catheter group , all patients in surgery group (100%) needed blood transfusion, ventilation and inotropic support, no one needed in catheter group (0%), LVEDD Z-Score showed statistical significant differences between surgery and catheter groups immediately after ( mean 3.41+0.924 vs 1.52+1.39 respectively),3 days after( mean 3.61+1.06 vs 1.45+1.39 respectively) and 1month after (mean 1.45+1.03 vs 0.768+1.44 respectively ) .cardiac enzymes ,systolic and diastolic functions were affected immediately post- operative and on 3^rd day follow up in surgery not in catheter group and returned to normal after one month follow up. Conclusion: Trans-catheter device closure of VSD is more safe and efficient than surgical closure, trans-catheter device closure had fewer myocardial injuries, shorter hospital stays and faster recovery times, also trans-catheter device closure had no systolic nor diastolic dysfunction as in surgical closure on short term follow up.

Keywords