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Transcatheter, surgical approaches comparable in children with certain congenital defects
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Among a cohort of children, surgical and transcatheter treatment of perimembranous ventricular septal defects, one of the most common subtypes of congenital heart disease, yielded comparable outcomes in terms of safety and efficacy. However, study results showed a higher rate of minor adverse events in the surgery arm.
Investigators from several sites in the United States and China conducted the prospective, randomized controlled trial to determine whether the surgical or transcatheter approach was safer and more effective in correcting perimembranous ventricular septal defects in a cohort of 229 children. Although surgical closure is an established treatment, open-heart surgery with cardiopulmonary bypass is an invasive procedure, according to the researchers. The transcatheter approach, although associated with high incidence rates of complete atrioventricular block, may be attractive because of its less invasive nature.
Participants were aged 3 to 12 years and were randomly assigned to one of the two approaches between January 2009 and July 2010. The investigators compared clinical, laboratory, procedural and follow-up data during a 2-year period.
The final analysis included 101 patients (mean age, 5.5 years) in the transcatheter group and 99 patients (mean age, 5.8 years) in the surgery group.
There was no mortality or major complications in either group.
There were 32 minor adverse events (32.3%) in the surgery group compared with seven (6.9%) in the transcatheter group (P<.001).
Significant differences were also reported, indicating that the transcatheter group had fewer transfusions, shorter hospital stays, reduced medical costs and faster recovery times.
The left ventricular end diastolic dimension returned to normal in both groups during the 2 years of follow-up.
Closure rates, adverse events and complications were similar between the two groups.
“Transcatheter device closure and surgical repair are effective interventions with excellent midterm results for treating [perimembranous ventricular septal defects] in children,” the researchers concluded, adding that as a result of the advantages observed in the transcatheter group, transcatheter device closure is the treatment of choice for perimembranous ventricular septal defects in children in this cohort.
Disclosure: The researchers report no relevant financial disclosures.
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