Huang Ting,Liu Jinqiao,Xiao Yunbin.Comparison of the efficacy of percutaneous transcatheter closure versus traditional surgical repair for permembranous ventricular septal defect with aortic valve prolapse[J].Journal of Clinical Pediatric Surgery,,():842-846.[doi:10.3760/cma.j.cn101785-202506033]
Comparison of the efficacy of percutaneous transcatheter closure versus traditional surgical repair for permembranous ventricular septal defect with aortic valve prolapse
- Keywords:
- Heart Septal Defects; Ventricular; Aortic Valve Prolapse; Endovascular Procedures; Surgical Procedures; Operative; Child
- Abstract:
- Objective To explore the efficacy of percutaneous transcatheter closure versus traditional surgical repair for permembranous ventricular septal defect with aortic valve prolapse and identify the risk factors of percutaneous interventional closure failure and adverse cardiac events,so as to provide evidence for clinical treatment selection.Methods A total of 96 children with perimembranous ventricular septal defect (pmVSD) combined with aortic valve prolapse (AVP) who were admitted to Hunan Children’s Hospital from January 2018 to December 2024 were retrospectively enrolled.They were divided into the transcatheter closure group (51 cases) and the conventional surgical repair group (45 cases) according to the treatment modality.General clinical data of the children were collected.Preoperative,intraoperative and postoperative follow-up data were used to compare the success rate of the procedure,changes in valvular regurgitation,residual shunt,incidence of arrhythmia,and perioperative indicators (operation time,length of hospital stay,intraoperative blood loss,hospitalization cost,etc.) between the two groups.Multivariate Logistic regression analysis was performed to identify independent risk factors for transcatheter closure failure and postoperative adverse cardiac events.Results The success rate of occlusion was 80.4%（41/51） in transcatheter group,while the success rate was 100% (45/45) in the surgical repair group.There were no significant differences between two groups regarding the changes in postoperative tricuspid valve regurgitation,incidence of arrhythmia and residual shunt at the last follow-up (P>0.05).Statistically differences were observed between two groups in operative duration [95(76,110) vs.145(135,158) min],hospital stay [7(6,10) vs.10(9,13) day],intraoperative blood loss [5(3,5) vs.20 (20) mL] and hospitalization expenses [38173(30423,42073) yuan vs 46021(43928,53518) yuan](P<0.05).Significant differences were found in the proportion of moderate-to-severe AVP (60% vs. 24%),proportion of pmVSD diameter ≥7 mm (100% vs. 49%) and proportion of occluder diameter ≥8 mm (80% vs. 24%) between transcather occlusion failure subgroup and successful occlusion subgroup.Logistic regression analysis revealed that preoperative grade of aortic valve prolapse (AVP) and occluder diameter were independent risk factors for occlusion failure and postoperative adverse cardiac events(P<0.05).Conclusion For children with pmVSD complicated by mild AVP and defect diameter less than 7 mm,precise preoperative evaluation and appropriate occluder selection enable percutaneous transcatheter closure to achieve short and medium term efficacy comparable to conventional surgical repair,with the advantages of faster recovery and lower hospitalization cost.For children with moderate to severe AVP and pmVSD diameter ≥7 mm,conventional surgical repair should be prioritized to reduce the risks of closure failure and postoperative complications.Given the relatively short follow up duration of this study,long term efficacy requires further verification through prolonged follow up and multicenter randomized controlled trials.
References:
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Memo
收稿日期:2025-6-15。
基金项目:湖南省卫生健康科研课题（20253920）
通讯作者:肖云彬,Email:xiaoyunbinrui@126.com