Clinical efficacy of transthoracic occlusion via a right subaxillary incision and conventional surgery in the treatment of ventricular septal defect: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Kun ,  SHEN Qihui , WANG Pingfan , BAI Xiling , JIA Xiangjie , WU Zhenyu , SONG Zheng , YAN Liwei , WANG Mingwei

Department of Pediatrics Heart Center, Henan Provincial Chest Hospital, Zhengzhou, 450000, P.R.China;

Corresponding author：

SHEN Qihui, Email: shengqihuii@tom.com

Keywords：

Congenital heart disease; right subaxillary incision; ventricular septal defect; conventional surgery; transthoracic occlusion

DOI：

10.7507/1007-4848.202008005

Video：

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Objective To analyze the clinical efficacy of transthoracic occlusion via a right subaxillary incision and conventional surgery in the treatment of ventricular septal defect (VSD).Methods The clinical data of patients with congenital VSD undergoing right subaxillary incision surgery in our hospital from January 2017 to January 2020 were retrospectively analyzed. According to the surgical methods, the patients were divided into two groups: a conventional surgery group (conventional group) and a transthoracic occlusion group (occlusion group). There were 221 patients in the conventional group, including 97 males and 124 females, with an average age of 2.6±2.2 years and an average weight of 13.4±6.2 kg; there were 185 patients in the occlusion group, including 90 males and 95 females, with an average age of 3.2±2.6 years and an average weight of 14.7±6.6 kg. The clinical effectiveness was compared.Results The success rate of surgery was 100% in both groups. The intraoperative blood loss was less in the occlusion group (P<0.05). The incision length, operation time, postoperative mechanical ventilation time, retention time in the intensive care unit, the time to resume normal diet and normal activities after operation were all shorter than those in the conventional group (P all <0.05). The total cost during hospitalization of the conventional group was less than that of the occlusion group (P<0.001). There was no statistical difference in the incidence rate of perioperative complications between the two groups (P>0.05). During the follow-up (15.8±8.8 months), the incidence of complications in the conventional group was higher than that in the occlusion group with a statistical difference (P<0.001).Conclusion Compared with conventional surgery, transthoracic occlusion for VSD via right subaxillary incision has the advantages of smaller incision, shorter operation time, less blood loss, shorter postoperative recovery time and less long-term complications. However, the total hospitalization cost is relatively high, mainly because of the high consumables cost, and the long-term effects still need further comparative observation.

Citation： LI Kun, SHEN Qihui, WANG Pingfan, BAI Xiling, JIA Xiangjie, WU Zhenyu, SONG Zheng, YAN Liwei, WANG Mingwei. Clinical efficacy of transthoracic occlusion via a right subaxillary incision and conventional surgery in the treatment of ventricular septal defect: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(12): 1466-1470. doi: 10.7507/1007-4848.202008005 Copy

1.	Liao Z, Chen H, Lin L, et al. Long-term outcomes after conventional surgical repair versus perventricular device occlusion for doubly committed subarterial ventricular septal defects: A propensity score matched study. Eur J Cardiothorac Surg, 2020, 57(5): 929-936.
2.	You T, Yi K, Ding ZH, et al. Transcatheter closure, mini-invasive closure and open-heart surgical repair for treatment of perimembranous ventricular septal defects in children: A protocol for a network meta-analysis. BMJ Open, 2017, 7(6): e015642.
3.	Li D, Zhou X, Li M, et al. Comparisons of perventricular device closure, conventional surgical repair, and transcatheter device closure in patients with perimembranous ventricular septal defects: A network meta-analysis. BMC Surg, 2020, 20(1): 115.
4.	Chen Q, Lin ZW, Hong ZN, et al. Comparison of transthoracic device closure and surgical repair with right submammary or right infra-axillary thoracotomy for perimembranous VSD. Thorac Cardiovasc Surg, 2019, 67(1): 8-13.
5.	Hu X, Peng B, Zhang Y, et al. Short-term and mid-term results of minimally invasive occlusion of ventricular septal defects via a subaxillary approach in a single center. Pediatr Cardiol, 2019, 40(1): 198-203.
6.	Jacobs JP, Mayer JE, Pasquali SK, et al. The Society of Thoracic Surgeons congenital heart surgery database: 2019 update on outcomes and quality. Ann Thorac Surg, 2019, 107(3): 691-704.
7.	Voitov A, Omelchenko A, Gorbatykh Y, et al. Outcomes of perventricular off-pump versus conventional closure of ventricular septal defects: A prospective randomized study. Eur J Cardiothorac Surg, 2017, 51(5): 980-986.
8.	Fang GH, Chen Q, Hong ZN, et al. The comparison of perventricular device closure with transcatheter device closure and the surgical repair via median sternotomy for perimembranous ventricular septal defect. Ann Thorac Cardiovasc Surg, 2018, 24(6): 308-314.
9.	Zhou Y, Liu LX, Zhao F, et al. Effects of transthoracic device closure on ventricular septal defects and reasons for conversion to open-heart surgery: A meta-analysis. Sci Rep, 2017, 7(1): 12219.
10.	Zhou Y, Liu LX, Zhao F, et al. Repair of ventricular septal defect through anterolateral thoracotomy with central cannulation: Our experience. Indian J Thorac Cardiovasc Surg, 2020, 36(5): 1-7.
11.	Beşir Y, Gökalp O, Karaağaç E, et al. Mini-thoracotomy versus median sternotomy for atrial septal defect closure: Should mini-thoracotomy be applied as a standard technique? Turk Gogus Kalp Damar Cerrahisi Derg, 2019, 27(3): 280-285.
12.	Hong Z, Chen Q, Lin ZW, et al. Surgical repair via submammary thoracotomy, right axillary thoracotomy and median sternotomy for ventricular septal defects. J Cardiothorac Surg, 2018, 13(1): 47.
13.	邵峻, 李小波, 张洵, 等. 经右侧腋下直切口外科矫治动脉导管未闭合并心内畸形的早期结果. 中国胸心血管外科临床杂志, 2020, 27(8): 922-925.
14.	An G, Zhang H, Zheng S, et al. Mid-term outcomes of common congenital heart defects corrected through a right subaxillary thoracotomy. Heart Lung Circ, 2017, 26(4): 376-382.
15.	夏麟, 段维勋, 李子林, 等. 外科修复和基于临床路径的经导管封堵膜周部室间隔缺损对比研究. 中国体外循环杂志, 2019, 17(4): 217-221, 238.
16.	Liu H, Lu FX, Zhou J, et al. Minimally invasive perventricular versus open surgical ventricular septal defect closure in infants and children: A randomised clinical trial. Heart, 2018, 104(24): 2035-2043.
17.	Chen Q, Hong ZN, Zhang GC, et al. Intraoperative device closure of isolated ventricular septal defects: Experience on 1, 090 cases. Ann Thorac Surg, 2018, 105(6): 1797-1802.

1. Liao Z, Chen H, Lin L, et al. Long-term outcomes after conventional surgical repair versus perventricular device occlusion for doubly committed subarterial ventricular septal defects: A propensity score matched study. Eur J Cardiothorac Surg, 2020, 57(5): 929-936.
2. You T, Yi K, Ding ZH, et al. Transcatheter closure, mini-invasive closure and open-heart surgical repair for treatment of perimembranous ventricular septal defects in children: A protocol for a network meta-analysis. BMJ Open, 2017, 7(6): e015642.
3. Li D, Zhou X, Li M, et al. Comparisons of perventricular device closure, conventional surgical repair, and transcatheter device closure in patients with perimembranous ventricular septal defects: A network meta-analysis. BMC Surg, 2020, 20(1): 115.
4. Chen Q, Lin ZW, Hong ZN, et al. Comparison of transthoracic device closure and surgical repair with right submammary or right infra-axillary thoracotomy for perimembranous VSD. Thorac Cardiovasc Surg, 2019, 67(1): 8-13.
5. Hu X, Peng B, Zhang Y, et al. Short-term and mid-term results of minimally invasive occlusion of ventricular septal defects via a subaxillary approach in a single center. Pediatr Cardiol, 2019, 40(1): 198-203.
6. Jacobs JP, Mayer JE, Pasquali SK, et al. The Society of Thoracic Surgeons congenital heart surgery database: 2019 update on outcomes and quality. Ann Thorac Surg, 2019, 107(3): 691-704.
7. Voitov A, Omelchenko A, Gorbatykh Y, et al. Outcomes of perventricular off-pump versus conventional closure of ventricular septal defects: A prospective randomized study. Eur J Cardiothorac Surg, 2017, 51(5): 980-986.
8. Fang GH, Chen Q, Hong ZN, et al. The comparison of perventricular device closure with transcatheter device closure and the surgical repair via median sternotomy for perimembranous ventricular septal defect. Ann Thorac Cardiovasc Surg, 2018, 24(6): 308-314.
9. Zhou Y, Liu LX, Zhao F, et al. Effects of transthoracic device closure on ventricular septal defects and reasons for conversion to open-heart surgery: A meta-analysis. Sci Rep, 2017, 7(1): 12219.
10. Zhou Y, Liu LX, Zhao F, et al. Repair of ventricular septal defect through anterolateral thoracotomy with central cannulation: Our experience. Indian J Thorac Cardiovasc Surg, 2020, 36(5): 1-7.
11. Beşir Y, Gökalp O, Karaağaç E, et al. Mini-thoracotomy versus median sternotomy for atrial septal defect closure: Should mini-thoracotomy be applied as a standard technique? Turk Gogus Kalp Damar Cerrahisi Derg, 2019, 27(3): 280-285.
12. Hong Z, Chen Q, Lin ZW, et al. Surgical repair via submammary thoracotomy, right axillary thoracotomy and median sternotomy for ventricular septal defects. J Cardiothorac Surg, 2018, 13(1): 47.
13. 邵峻, 李小波, 张洵, 等. 经右侧腋下直切口外科矫治动脉导管未闭合并心内畸形的早期结果. 中国胸心血管外科临床杂志, 2020, 27(8): 922-925.
14. An G, Zhang H, Zheng S, et al. Mid-term outcomes of common congenital heart defects corrected through a right subaxillary thoracotomy. Heart Lung Circ, 2017, 26(4): 376-382.
15. 夏麟, 段维勋, 李子林, 等. 外科修复和基于临床路径的经导管封堵膜周部室间隔缺损对比研究. 中国体外循环杂志, 2019, 17(4): 217-221, 238.
16. Liu H, Lu FX, Zhou J, et al. Minimally invasive perventricular versus open surgical ventricular septal defect closure in infants and children: A randomised clinical trial. Heart, 2018, 104(24): 2035-2043.
17. Chen Q, Hong ZN, Zhang GC, et al. Intraoperative device closure of isolated ventricular septal defects: Experience on 1, 090 cases. Ann Thorac Surg, 2018, 105(6): 1797-1802.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical efficacy of transthoracic occlusion via a right subaxillary incision and conventional surgery in the treatment of ventricular septal defect: A retrospective cohort study

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