LAUSR

This retrospective, single-center study evaluated short-term and mid-term results of minimally invasive surgery to occlude ventricular septal defects (VSDs) using a subaxillary approach. The procedure was performed on 429 children (224 boys, 205 girls; age 2.4 ± 2.5 years; mean weight 12.7 ± 10.1 kg) between January 2014 and December 2016 at the Children’s Heart Center of Henan Province People’s Hospital. An approximately 2-cm subaxillary incision was made between the third and fifth ribs, and the appropriate right atrium or ventricle was punctured under the guidance of transencephalographic echocardiography (TEE). The VSD was then occluded under TEE guidance. The mean size of the VSDs was 4.2 ± 1.0 mm, and the occluder measured 5.3 ± 1.3 mm. Asymmetrical occluders were used in 44 patients and symmetrical occluders in 385 patients. The operative time was 60.7 ± 21.3 min, and time in the intensive care unit was 20.9 ± 6.5 h. Blood loss was 12.4 ± 14.4 ml. There were no deaths among these patients. Occluder displacement occurred in two cases. There were no complications (e.g., third-degree atrioventricular block, new aortic regurgitation, reoperation for massive bleeding, serious infection). All patients were followed for 6–48 months, during which time there were ten cases of a postoperative residual shunt, which self-closed in eight during follow-up. The other two cases are still being followed. No complications occurred during follow-up (e.g., reoperation, aortic regurgitation, atrioventricular block, occluder abscission). Occluding VSDs using the subaxillary approach is safe and effective. Short-term and mid-term results are satisfactory. Further follow-up is required regarding long-term results.