The Short And Midterm Follow-up And The Quality Of Life Analysis Of Transthoracic Device Closure Of Perimembranous Ventricular Septal Defect In Adults

ObjectiveThe purpose of this study was to evaluate the short-and medium-term follow-up results of transthoracic device occlusion of perimembranous ventricular septal defect(pmVSD)in adults,and to analyze the health-related quality of life of this kind of operation,summarize the clinical experience of the operation,reduce the related complications,analyze the health-related quality of life of patients,and provide a reference for the preoperative choice of surgical methods for such patients.MethodsSeventy-one adults who underwent transthoracic device occlusion of perimembranous ventricular septal defect(pmVSD)in our hospital from January 2012 to September 2017 were selected as subjects.All patients underwent necessary auxiliary examinations before operation.All clinical data were recorded and the related transthoracic echocardiography data were recorded.All patients were followed up for 12 to 35 months by transthoracic echocardiography,and telephone interviews were conducted.The data of transthoracic echocardiography at 3 months and 1 year after operation were recorded.Further evaluation of cardiac function.The MOS item short from health survey(SF-36)were completed before surgery and re-evaluated one year after surgery to assess health-related quality of life.LSD test was used to compare the data of transthoracic echocardiography measured repeatedly at different time points.Mann-Whitney U test or Kruskal-Wallis H(K)test was used to analyze the difference of SF-36 among groups after operation.Sex group,marital status group,Mann-Whitney U test was used in postoperative patients and healthy adults.Kruskal-Wallis H(K)test was used for education group and age group.Wilcoxon(W)test was used in preoperative group and postoperative group,there was significant difference between the two groups(p < 0.05).ResultsAll patients were successfully occluded with this operation.The most common complication is transient arrhythmia,which is easy to treat during perioperative period.During follow-up,we found no recurrence,delayed III degree atrioventricular block,thrombosis,valvular injury,or death.The total occlusion rate was 100% after 12 months follow-up,and the clinical status of most of the patients was significantly improved.In the follow-up data,both cardiac structure and cardiac function were improved.But there was no statistical difference in all changes in heart size.The quality of life related to health was significantly improved compared with that before operation.ConclusionCompared with traditional CPB heart surgery and transcatheter interventional minimally invasive surgery,minimally invasive transthoracic closure without CPB is a new and effective treatment method with small trauma,good operability and safety,the indications are relatively wide,the complications are few,and the quality of postoperative survival is satisfactory.As a result of the use of domestic delivery sheaths and umbrellas,this procedure is feasible and cheap,and the use of such devices should be promoted.However,long-term follow-up is needed to better assess the safety and feasibility of this method in adults.