Ruth Solana-Gracia1, Alberto Mendoza Soto2, José Ignacio Carrasco Moreno3, María Jesús Del Cerro Marín4, Federico Gutiérrez-Larraya Aguado5, José Félix Coserría Sánchez6, Roberto Blanco Mata7, Fredy Hermógenes Prada Martínez8, Manuel Pan Álvarez-Ossorio9, Lorenzo Jiménez Montañés10, Armando Pérez de Prado11, María Del Mar Rodríguez Vázquez Del Rey12, Hipólito Gutiérrez García13, José Manuel Velasco Bayón2, José Luis Zunzunegui Martínez14. 1. Unidad de Cardiología Infantil, Hospital Universitario Infanta Leonor, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. Electronic address: ruth.solana@salud.madrid.org. 2. Instituto Pediátrico del Corazón, Hospital Universitario 12 de Octubre, Madrid, Spain. 3. Servicio de Cardiología Infantil, Hospital Universitario La Fe, Valencia, Spain. 4. Servicio de Cardiología Infantil, Hospital Universitario Ramón y Cajal, Madrid, Spain. 5. Servicio de Cardiología Infantil, Hospital Universitario La Paz, Madrid, Spain. 6. Servicio de Cardiología Infantil, Hospital Virgen del Rocío, Sevilla, Spain. 7. Servicio de Cardiología, Hospital Universitario de Cruces, Bilbao, Vizcaya, Spain. 8. Servicio de Cardiología Infantil, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain. 9. Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain. 10. Unidad de Cardiología Infantil, Hospital Universitario Miguel Servet, Zaragoza, Spain. 11. Servicio de Cardiología, Hospital Universitario de León, León, Spain. 12. Servicio de Cardiología Infantil, Hospital Universitario Virgen de las Nieves, Granada, Spain. 13. Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, Spain. 14. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Unidad de Cardiología Infantil, Hospital Universitario Gregorio Marañón, Madrid, Spain.
Abstract
INTRODUCTION AND OBJECTIVES: The NitOcclud Lê VSD Coil was specifically designed for transcatheter occlusion of ventricular septal defects (VSD) and became available for this purpose in August 2010. Our objective was to describe the Spanish experience of this technique and analyze its reliability and short- to mid-term efficacy. METHODS: National multicenter observational study, which retrospectively recruited all patients (of any age) with VSD (of any location or type) who underwent percutaneous NitOcclud occlusion, using an intention-to-treat analysis, until January 2019. RESULTS: A total of 117 attempts were made to implant at least 1 NitOcclud in 116 patients in 13 institutions. The median [range] age and weight was 8.6 [0.4-69] years and 27 [5.8-97] kg, respectively. In 99 patients (85%), the VSD was an isolated congenital defect. The location was perimembranous in 95 (81%), and 74 (63%) of them were aneurysmatic. The mean fluoroscopy time was 34 [11.4-124] minutes. Of the 117 attempts, 104 were successful (89%) with a follow-up of 31.4 [0.6-59] months. At the last review, final complete occlusion of the defect without residual shunt or with only a minimal shunt was achieved in 92.3% (no shunt, n=73; trivial shunt, n=23). Four patients required a second procedure for residual shunt occlusion. Two devices had to be surgically explanted due to severe hemolysis. There were no deaths or other major complications. CONCLUSIONS: The NitOcclud device can be used successfully for a wide anatomical spectrum of VSD. The main issue is residual shunt, but its incidence decreases over time. The incidence of hemolysis was very low and no permanent changes were detected in atrioventricular conduction.
INTRODUCTION AND OBJECTIVES: The NitOcclud Lê VSD Coil was specifically designed for transcatheter occlusion of ventricular septal defects (VSD) and became available for this purpose in August 2010. Our objective was to describe the Spanish experience of this technique and analyze its reliability and short- to mid-term efficacy. METHODS: National multicenter observational study, which retrospectively recruited all patients (of any age) with VSD (of any location or type) who underwent percutaneous NitOcclud occlusion, using an intention-to-treat analysis, until January 2019. RESULTS: A total of 117 attempts were made to implant at least 1 NitOcclud in 116 patients in 13 institutions. The median [range] age and weight was 8.6 [0.4-69] years and 27 [5.8-97] kg, respectively. In 99 patients (85%), the VSD was an isolated congenital defect. The location was perimembranous in 95 (81%), and 74 (63%) of them were aneurysmatic. The mean fluoroscopy time was 34 [11.4-124] minutes. Of the 117 attempts, 104 were successful (89%) with a follow-up of 31.4 [0.6-59] months. At the last review, final complete occlusion of the defect without residual shunt or with only a minimal shunt was achieved in 92.3% (no shunt, n=73; trivial shunt, n=23). Four patients required a second procedure for residual shunt occlusion. Two devices had to be surgically explanted due to severe hemolysis. There were no deaths or other major complications. CONCLUSIONS: The NitOcclud device can be used successfully for a wide anatomical spectrum of VSD. The main issue is residual shunt, but its incidence decreases over time. The incidence of hemolysis was very low and no permanent changes were detected in atrioventricular conduction.