P4696Short- and long-term follow-up of 1024 Children with transcatheter closure of ventricular septal defects: A Single center Study
Authors: Han B , Meng K H , Wang J I N G , Jiang D D , Fan Y F , Lv J L , Zhao L J , Yi Y C , Zhang J J 
Published: October 2019

Abstract

Objective
To investigate the safety, efficacy and long-term prognosis of pediatric patients after percutaneous ventricular septal defect (VSD) closure.

Method
A total of 1024 children with VSD in were enrolled. All children underwent transthoracic echocardiography (TTE), electrocardiogram (ECG) and chest roentgenogram before and after the treatment. Follow-up evaluation was done at 1, 3, 6, 12 months.

Results
1. 40 of 1024 patients gave up TC after angiography. Successful closure of VSD was achieved in 94.9% (934/984).
2. The defect were successfully occluded in 934 children. 939 VSD devices were implanted, 5 patients received 2 occluders. The average diameter of occluder was 6.40±2.13mm (3.00–18.00mm), and the mean operation time was 86.81±41.85min (30.00–360.00min).
3. Short postoperative complications were as follows: diffuse subarachnoid hemorrhage (1/934, 0.11%), high or complete atrioventricular block (1/934, 0.32%), mechanical hemolysis occurred (18/934, 1.93%). Moreover, the conduction disturbances included complete left bundle branch block (15/934, 1.61%), incomplete right bundle branch block (144/934, 15.42%), borderline rhythm (48/93, 45.14%), and complete right bundle branch block (44/934, 4.71%), left anterior branch block (27/934, 2.89%), premature contraction (21/934, 2.36%), ST-T segment changes (12/934, 1.28%).
4. The follow-up time ranged from1 to 192 months with the median time 36 months (12, 60) and the follow-up rate was 84.1% (795/934). There was no difference of mean left ventricular size between normal outpatients and patients accepted TC for more than 10 years (4.50±0.30cm V.S. 4.57±0.35cm, t=1.171, P=0.251).
5. New complications included III°AVB (1 case), CLBBB (1 case), ARs (27 cases) and residual shunt (12 cases). The operation age, the distance from defect to valve, the occluder diameter, the asymmetrical occluder and follow-up duration were associated risk factors of AR (OR= 4.107, 5.30, 3.824, 6.750, 9.625, P=0.033, 0.015, 0.045, 0.020, 0.000, respectively). The difference of occluder diameter, defect size and follow-up time were related risk factors of residual shunt (OR=7.000, 5.417, 11.333, 29.250, P=0.012, 0.037, 0.031, 0.000, respectively).
6. The patients were divided into 4 groups (∼3 years group, 3 ∼ 4 years group, 4∼ 6 years group, and 6∼ 18 years group. No significant differences of the success rate, defect size, operation time, incidence rate of short- and long-term complications rate. There was significantly difference of short complications incidence rate in 4 groups (c2=23.431 P=0.000).

Conclusions
The TC has a high successful rate in the pediatric patients with VSD. Patients with CLBBB or III°AVB can return to normal in the early stage after operation, but may recur during follow-up period. There is no significant difference in the successful rate and the incidence rate of long-term complications between patients <3 years and children ≥3 years old.

Acknowledgement/Funding
Taishan scholars (no. ts201511099)