What is the clinical evidence from this study?

Study design: Cohort. Population: Ventricular septal defect (VSD) (n=773). Intervention: Intracristal VSD vs. Other VSD types. Primary outcome: Unplanned surgery after transcatheter closure (OR 8.731, 95% CI 2.274-33.527, p=0.002).

November 30, 2021Frontiers in Pediatrics15 citationsOpen Access

Unplanned Surgery After Transcatheter Closure of Ventricular Septal Defect in Children: Causes and Risk Factors

PYPenghui Yang ZWZhijun Wu ZLZhiyuan Liu

Key Result

Unplanned surgery occurred in 3.1% of children after transcatheter VSD closure, with intracristal VSD significantly increasing the risk (OR 8.731) alongside primary aortic valve prolapse and eccentric occluder use.

Study Design

Type

Cohort (n=773)

Multicenter

Structured PICO

What are the causes and risk factors for unplanned surgery after transcatheter closure of ventricular septal defect in children?

Population

773 children under 18 years of age with ventricular septal defect who underwent transcatheter closure, followed for a median of 5 years.

Exposure

Transcatheter closure of VSD using modified double-disk occluders (symmetric, eccentric, small-waist, or muscular)

Outcome

Unplanned surgery after transcatheter closure of VSDsafety

New-onset or worsening aortic regurgitation is the primary cause of unplanned surgery after transcatheter VSD closure in children, with risk significantly increased by primary aortic valve prolapse, intracristal VSD, eccentric occluders, larger occluder size, and elevated pulmonary artery systolic pressure.

Main Result

Odds Ratio: 8.731 (95% CI 2.274–33.527)

Absolute Event Rate: 31.8% vs 2.1%

p-value: p=0.002

Limitations

Single-center retrospective study design
Limited sample size restricting generalizability
Only explored preoperative and selected intraoperative factors, missing other potential postoperative variables
Single-center retrospective study
Limited sample size
Limited generalizability
Only explored preoperative and selected intraoperative factors

Abstract

Objectives: To evaluate the causes and risk factors of unplanned surgery after transcatheter closure of ventricular septal defect (VSD) in children. Methods: A total of 773 patients with VSD who had the devices transcatheter released between January 2013 and December 2018 in our institution were retrospectively reviewed. Univariate and multivariate analyses were used to identify the risk factors for unplanned surgery. Results: Twenty four patients (3.1%) underwent unplanned surgery after transcatheter closure of VSD. The most common cause for unplanned surgery was new-onset or worsening aortic regurgitation (14/24; 58.3%), followed by occluder migration (4/24; 16.7%), complete atrioventricular block (2/24; 8.3%), severe hemolysis (2/24; 8.3%), residual shunt (1/24; 4.2%), and occluder edge near the tricuspid valve chordae (1/24; 4.2%). Logistic regression analysis revealed that primary aortic valve prolapse (OR: 5.507, 95%CI: 1.673–18.123, P = 0.005); intracristal VSD (OR: 8.731, 95%CI: 2.274–33.527, P = 0.002); eccentric occluder (OR: 4.191, 95%CI: 1.233–14.246, P = 0.022); larger occluder size (OR: 1.645, 95%CI: 1.331–2.033, P 0.001); and pulmonary artery systolic pressure ≥45 mmHg (OR: 4.003, 95%CI: 1.073–14.941, P = 0.039) were risk factors for unplanned surgery. Conclusions: New-onset or worsening aortic regurgitation was the primary cause for unplanned surgery after transcatheter closure of VSD in children. Primary aortic valve prolapse, intracristal VSD, eccentric occluder, larger occluder size, pulmonary artery systolic pressure ≥45 mmHg could increase the risk of unplanned surgery.

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