Mid-to-long-term outcomes of minimally invasive transthoracic device closure in perimembranous ventricular septal defect: a single-center retrospective cohort study

To review mid-to-long-term outcomes of minimally invasive transthoracic device closure (MITC) of perimembranous ventricular septal defect (pmVSD) and to identify the risk factors associated with postoperative complications. Data from consecutive patients who met the preoperative screening criteria for MITC from January 2011 to December 2019 were retrospectively reviewed ( N = 1979). Preoperative, intraoperative, postoperative, and follow-up data were collected. Patients who underwent successful MITC constituted the follow-up cohort. Multivariable logistic regression was used to identify factors associated with postoperative complications. Among 1979 selected patients, 1822 patients (92.1%) completed MITC successfully. The median follow-up duration was 87 months (58–113). No death was documented in the available medical and follow-up records. Persistent arrhythmias were observed in 344 cases (18.9%), among which 310 (17%) were classified as incomplete right bundle branch block, and 65 (3.6%) were classified as severe arrhythmias. All cases of postoperative valvular regurgitation (8 cases, 0.4%) were mild and did not need additional intervention. Residual shunts were observed in 112 cases (6.1%), and the majority of these residual shunts closed spontaneously during follow-up. Multivariable analysis revealed that asymmetric pmVSD with aneurysm (OR, 1.651; 95% CI, 1.288–2.116; P < 0.001) and a larger difference in diameter between the occluder and the defect (OR, 1.309; 95% CI, 1.077–1.591; P = 0.007) were independent risk factors for postoperative arrhythmias. MITC for selected patients with pmVSD demonstrated acceptable safety and efficacy profiles, with satisfactory mid-to-long-term outcomes. Most adverse events were mild and manageable. Asymmetric pmVSD with aneurysm may predict postoperative arrhythmias.