Early and mid-term results of minimally invasive occlusion via the subaxillary route for ventriculal septal defect: a single institute experience / 中华胸心血管外科杂志

ABSTRACT

Objective This retrospective,single-center study evaluated short-and mid-term results of minimally invasive surgery to occlude ventricular septal defects(VSDs) through right subaxillary approach.Methods The procedure was performed on 624 children,224 boys and 205 girls;aged(2.4 ± 2.2) years;mean weight(12.3 ± 10.2)kg between January 2014 to December 2017 at the Children' s Heart Center of Henan Province People' s Hospital.An approximately 2 cm right subaxillary incision was made between the third and fifth ribs.The right atrium or ventricle was punctured under the guidance of transencephalographic echocardiography(TEE).The VSD was occluded under TEE guidance.Results The mean size of VSDs was(4.2 ±0.9)mm,and the occluder measured(5.2 ± 1.2)mm.Asymmetrical occluders were used in 28 patieuts and symmetrical occluders in 596 patients.The operative time was(58.5 ± 20.2) minutes,and the time in the intensive care unit (ICU) was(19.4 ±6.7) h.Blood loss was(10.4 ±9.5) ml.There were no deaths among these patients.Occluder displacement occurred in two cases.The complications such as Ⅲ degree atrioventricular block,new aortic regurgitation,reoperation foi massive bleeding,and serious infection were not observed.All patients were followed up for 6-48 months.There were 15 cases of residual shunt after operation.Eight cases were self-closed during follow-up,and 5 cases were still followed up.No complications such as reoperation,aortic regurgitation,atrioventricular block or occluder abscission was observed during the follow-up period.Conclusion Occluding VSDs using the right subaxillary approach is safe and effective.Short-term and midterm results are satisfactory.Further follow-up is required regarding long-term results.