Results of two different approaches to closure of subaortic ventricular septal defects in children.

Objectives: Percardiac device closure of ventricular septal defects (VSDs) is considered as an alternative to surgical repair in certain patients; however, the safety and validity of this technique in subaortic VSD are unproven.

Methods: A total of 463 patients with subaortic VSD underwent two different operative procedures. The clinical data were collected and a retrospective analysis was performed.

Results: A total of 145 (90.06%) cases were successfully occluded in Group A, and 16 (9.94%) patients were converted to open-heart surgery after occlusion procedure failure. A total of 302 patients in Group B underwent open-heart surgery. Multivariable analysis showed that a diameter of <5 mm in doubly committed subarterial VSD was the sole predictor of device closure failure. There were statistically significant differences (P < 0.05) between the two groups in operation time, postoperative mechanical ventilation time, cardiac intensive care unit duration, postoperative hospitalization time and blood transfusion requirement. Patients were followed up with clinical examination, echocardiography (ECG) and transthoracic ECG during the period of 3-36 months (median, 12.6 months) at second week, third month, sixth month, first year, second year and third year after the operation. No acute complications or severe adverse events (death, valve injury, complete atrioventricular block and embolism) occurred either in the early period or during the follow-up.

Conclusions: Percardiac device occlusion is a safe, effective and efficient option for treating subaortic VSD in selected patients.