Transthoracic percutaneous device closure for doubly committed subarterial ventricular septal defect: A single-center 13-year outcome_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIE Lin , WU Zhuheng , LAN Tu , LIU Jingyu , ZHENG Xingyu ,  LIN Ke

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding?author：

LIN Ke, Email: edidian@163.com

Keywords：

Doubly committed subarterial ventricular septal defect; transthoracic percutaneous device closure; aortic regurgitation; residual shunts; pulmonary regurgitation; adverse outcomes

DOI：

10.7507/1007-4848.202601030

Video：

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Objective To summarize the mid-term outcomes and surgical experience of transthoracic device closure for doubly committed subarterial ventricular septal defect (dcsVSD) in our center. Methods Patients with dcsVSD who underwent transthoracic device closure in the Department of Cardiovascular Surgery, West China Hospital, Sichuan University, from January 2013 to October 2025 were retrospectively enrolled. Baseline characteristics, perioperative data, and follow-up data were analyzed. Results A total of 68 patients were enrolled, including 35 (52.9%) males and 33 (47.1%) females, with a median age of 1.8 (1.0, 3.0) years and a median VSD diameter of 4.0 (3.0, 5.0) mm. The defects were successfully closed using eccentric VSD occluders in all patients, with a median operative time of 24.0 (20.0, 40.0) min and a median eccentric VSD occluder diameter of 7.0 (6.0, 8.0) mm. The median follow-up duration was 59.0 (29.5, 74.3) months. New-onset aortic regurgitation during follow-up was observed in 5 (7.4%) patients, among whom 1 patient underwent reoperation. No patient had residual shunt at the latest follow-up. No occluder displacement, new-onset atrioventricular block, or left/right ventricular outflow tract obstruction occurred during the follow-up. Conclusion Transthoracic device closure for dcsVSD yields relatively satisfactory mid-term outcomes. Meticulous preoperative evaluation and more stringent patient selection are crucial to avoid new-onset aortic regurgitation during the follow-up.

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14.	Hu X, Peng B. Asymmetric occluder occlusion of outlet ventricular septal defect via a subaxillary approach. Ann Thorac Surg, 2021, 112(5): 1532-1536.
15.	Liao ZM, Chen H, Lin L, et al. Long-term outcomes after conventional surgical repair versus perventricular device occlusion for doubly committed subarterial ventricular septal defects: a propensity score matched study. Eur J Cardiothorac Surg, 2020, 57(5): 929-936.
16.	Pan S, Xing Q, Cao Q, et al. Perventricular device closure of doubly committed subarterial ventral septal defect through left anterior minithoracotomy on beating hearts. Ann Thorac Surg, 2012, 94(6): 2070-2075.
17.	Yang Y, Xi L, Li H. A retrospective study in occluding sub-arterial ventricular septal defect. Pediatr Cardiol, 2024, 45(2): 410-415.
18.	Roymanee S, Su-angka N, Promphan W, et al. Outcomes of transcatheter closure in outlet-type ventricular septal defect after 1 year. Congenit Heart Dis, 2023, 18(2): 169-181.
19.	Huang JS, Sun KP, Huang ST, et al. A meta-analysis of perventricular device closure of doubly committed subarterial ventricular septal defects. J Cardiothorac Surg, 2020, 15(1): 28.
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25.	Fox MP, Edwards JK, Platt R, et al. The critical importance of asking good questions: the role of epidemiology doctoral training programs. Am J Epidemiol, 2020, 189(4): 261-264.
26.	Feng S, Wang H, He X, et al. Impact of mitral valve interventions on left ventricular hemodynamics: insights into energy loss and flow dynamics. JTCVS Open, 2025, 26: 104-114.

1. Penny DJ, Vick GW. Ventricular septal defect. Lancet, 2011, 377(9771): 1103-1112.
2. Lopez L, Houyel L, Colan SD, et al. Classification of ventricular septal defects for the eleventh iteration of the International Classification of Diseases: striving for consensus: a report from the International Society for Nomenclature of Paediatric and Congenital Heart Disease. Ann Thorac Surg, 2018, 106(5): 1578-1589.
3. Cao H, Chen Q, Zhang GC, et al. Transthoracic subarterial ventricular septal defect occlusion using a minimally invasive incision. J Card Surg, 2016, 31(6): 398-402.
4. Sim EKW, Grignani RT, Wong ML, et al. Outcome of surgical closure of doubly committed subarterial ventricular septal defect. Ann Thorac Surg, 1999, 67(3): 736-738.
5. De Leval MR, Pozzi M, Starnes V, et al. Surgical management of doubly committed subarterial ventricular septal defects. Circulation, 1988, 78(5 Pt 2): Ⅲ40-Ⅲ46.
6. Turner ME, Bouhout I, Petit CJ, et al. Transcatheter closure of atrial and ventricular septal defects: JACC focus seminar. J Am Coll Cardiol, 2022, 79(22): 2247-2258.
7. Huang Y, Yan X, Lu L, et al. Transcatheter closure of doubly committed subarterial ventricular septal defects with the Amplatzer ductal occluder: initial experience. Cardiol Young, 2019, 29(5): 570-575.
8. Yang CZ, Hua C, Ji MY, et al. Transfemoral and perventricular device occlusions and surgical repair for doubly committed subarterial ventricular septal defects. Ann Thorac Surg, 2015, 99(5): 1664-1670.
9. Gan C, Peng L, Liang Z, et al. Percutaneous perventricular device closure of ventricular septal defect: from incision to pinhole. Ann Thorac Surg, 2017, 103(1): 172-177.
10. Wu Z, Zhang S, Xie L, et al. Device closure versus surgical repair for doubly committed subarterial ventricular septal defect. J Thorac Cardiovasc Surg, 2025, 170(3): 815-826. e10.
11. Wang L, Xie L, Ruan W, et al. Percutaneous-perventricular device closure of ventricular septal defect: mid-term follow-up. BMC Surg, 2020, 20(1): 208.
12. An K, Li S, Yan J, et al. Minimal right vertical infra-axillary incision for repair of congenital heart defects. Ann Thorac Surg, 2022, 113(3): 896-902.
13. Haller C, Karunasumetta C, Zubair A, et al. Single incision minimally invasive congenital heart surgery-insights into program development and outcome. J Thorac Cardiovasc Surg, 2025. [Epub ahead of print].
14. Hu X, Peng B. Asymmetric occluder occlusion of outlet ventricular septal defect via a subaxillary approach. Ann Thorac Surg, 2021, 112(5): 1532-1536.
15. Liao ZM, Chen H, Lin L, et al. Long-term outcomes after conventional surgical repair versus perventricular device occlusion for doubly committed subarterial ventricular septal defects: a propensity score matched study. Eur J Cardiothorac Surg, 2020, 57(5): 929-936.
16. Pan S, Xing Q, Cao Q, et al. Perventricular device closure of doubly committed subarterial ventral septal defect through left anterior minithoracotomy on beating hearts. Ann Thorac Surg, 2012, 94(6): 2070-2075.
17. Yang Y, Xi L, Li H. A retrospective study in occluding sub-arterial ventricular septal defect. Pediatr Cardiol, 2024, 45(2): 410-415.
18. Roymanee S, Su-angka N, Promphan W, et al. Outcomes of transcatheter closure in outlet-type ventricular septal defect after 1 year. Congenit Heart Dis, 2023, 18(2): 169-181.
19. Huang JS, Sun KP, Huang ST, et al. A meta-analysis of perventricular device closure of doubly committed subarterial ventricular septal defects. J Cardiothorac Surg, 2020, 15(1): 28.
20. Cashin AG, Hansford HJ, Hernán MA, et al. Transparent reporting of observational studies emulating a target trial: the TARGET statement. JAMA, 2025, 334(12): 1084-1093.
21. 袁馳, 周祎靈, 曹雨滋, 等. 基于真實世界數據的觀察性研究因果推斷: 目標試驗模擬實施要點及案例分析. 中國胸心血管外科臨床雜志, 2024, 31(12): 1743-1752.Yuan C, Zhou YL, Cao YZ, et al. Causal inference in observational studies based on real-world data: key points and case studies for target trial emulation. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(12): 1743-1752.
22. Hernán MA, Sauer BC, Hernández-Díaz S, et al. Specifying a target trial prevents immortal time bias and other self-inflicted injuries in observational analyses. J Clin Epidemiol, 2016, 79: 70-75.
23. Robinson CH, Fan E, Grandi SM, et al. Target trial emulation in paediatric research: how can causal effects be estimated from observational data? Lancet Child Adolesc Health, 2025, 9(9): 663-672.
24. Feeney T, Zivich PN. Causal inference is hard, and advanced statistical analysis is not enough. BMJ, 2025, 391: r2618.
25. Fox MP, Edwards JK, Platt R, et al. The critical importance of asking good questions: the role of epidemiology doctoral training programs. Am J Epidemiol, 2020, 189(4): 261-264.
26. Feng S, Wang H, He X, et al. Impact of mitral valve interventions on left ventricular hemodynamics: insights into energy loss and flow dynamics. JTCVS Open, 2025, 26: 104-114.

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