Mid-Term Outcome of the Hybrid Method of Ventricular Septal Defect Closure in Children.

Akkerbez Adilbekova 1 2 * , Bakhytzhan Nurkeev 1, Shukhrat Marassulov 1, Saken Kozhakhmetov 2
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1 Pediatric Cardiac Surgery Department, National Scientific Medical Center, Astana City, Republic of Kazakhstan
2 Department of Surgical Diseases with courses in cardiothoracic surgery and maxillofacial surgery, Аstana Medical University, Astana City, Republic of Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 21, Issue 2, pp. 66-72. https://doi.org/10.23950/jcmk/14401
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Author Contributions: Conceptualization, A.A and N.B.; methodology, A.A., N.B., M.Sh. and K.S.; validation, A.A and N.B.; formal analysis, A.A., N.B., M.Sh.; investigation, A.A and N.B.; resources, A.A and N.B.; data curation, M.Sh. and K.S.; writing – original draft preparation, A.A and N.B.; writing – review and editing, N.B., M.Sh. and K.S.; visualization, A.A., N.B., M.Sh. and K.S.; supervision, M.Sh. and K.S.; project administration, M.Sh. and K.S.; funding acquisition, M.Sh. and K.S. All authors have read and agreed to the published version of the manuscript.

Ethical Statement: This research protocol was approved by the Ethics Committee of National Scientific Medical Center, Astana, Kazakhstan (Protocol number: 081/CR-75; Assigned number: 053/СТ-63) and carried out by the principles set out in the Declaration of Helsinki 1964.


Objective: To describe the clinical experiences and mid-term follow-up results of the hybrid method of ventricular septal defect closure in children.
Methods: This study was a combined - multidirectional cohort. Between May 2016 and December 2020, 250 patients with isolated VSD (or residual VSD after a previous repair) underwent surgery by the hybrid method at the pediatric cardiac surgery department in the National Scientific Medical Center. This study adopted a combined and multidirectional cohort approach, initially starting as a retrospective cohort and later transitioning into a prospective cohort.
Results: A total of 250 patients in this cohort underwent hybrid VSD closure, of which 233 (93.2%) patients were successful, 16 (6.4%) patients were converted to the traditional method and 1 (0.4%) death occurred. New trivial or mild tricuspid regurgitation was detected in 35 patients (15%) and aortic regurgitation in 9 patients (3.9%) by intraoperative TEE. For the remaining 10 patients with incomplete right bundle branch blocks the sinus rhythm was restored in follow-up. In addition, the left ventricular ejection fraction improved over time. One of the important points after surgery is the deformation of the chest. In 122 (91%) patients, there is no deformation; unfortunately, in 12 (9%) patients, there is deformation. 
Conclusions: The hybrid method is a rapidly developing technique that has been safe and effective in a selected group of patients in recent years. The advantages of this method are minimum incision namely the size and length of the postoperative scar from 2 to 4 cm. Also, no myocardial injury, and reduces operation time, intensive care unit stay, and hospital stays.


Adilbekova A, Nurkeev B, Marassulov S, Kozhakhmetov S. Mid-Term Outcome of the Hybrid Method of Ventricular Septal Defect Closure in Children.. J CLIN MED KAZ. 2024;21(2):66-72. https://doi.org/10.23950/jcmk/14401


  • Lu W, Zhang F, Fan T, et al. Minimally-invasive-perventricular-device-occlusion versus surgical-closure for treating perimembranous-ventricular-septal-defect: 3-year outcomes of a multicenter randomized clinical trial. J Thorac Dis. 2021;13(4):2106-2115. https://doi.org/10.21037/jtd-20-3298
  • Gan C, An Q, Lin K, et al. Perventricular Device Closure of Ventricular Septal Defects: Six Months Results in 30 Young Children. Ann Thorac Surg. 2008;86(1):142-6. https://doi.org/10.1016/j.athoracsur.2008.03.058
  • 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. https://doi.org/ 10.1016/j.athoracsur.2021.01.052
  • Adilbekova A, Marasulov S, Nurkeyev B, et al. Evolution of surgery of ventricular septal defect closure. J Clin Med Kazakhstan. 2022;19(5):4-8. https://doi.org/10.23950/jcmk/12505
  • Thakkar B, Patel N, Shah S, et al. Perventricular device closure of isolated muscular ventricular septal defect in infants: a single centre experience. Indian Heart J. 2012;64(6):559-67. https://doi.org/10.1016/j.ihj.2012.09.006
  • Kaiyu Tao,Ke Lin,Yingkang Shi, et al. Perventricular device closure of perimembranous ventricular septal defects in 61 young children: Early and midterm followup results. J. Thorac. Cardiovasc. Surg. 2010;140(4). https://doi.org/10.1016/j.jtcvs.2010.05.013
  • Ou-Yang W Bin, Wang SZ, Zhang DW, et al. Echocardiographic guided closure of perimembranous ventricular septal defects. Ann Thorac Surg. 2015;100(4):1398-402. https://doi.org/10.1016/j.athoracsur.2015.05.036
  • Michel-Behnke I, Ewert P, Koch A, et al. Device closure of ventricular septal defects by hybrid procedures: A multicenter retrospective study. Catheter Cardiovasc Interv. 2011;77(2):242-51. https://doi.org/10.1002/ccd.22666
  • Zhang GC, Chen Q, Cao H, et al. Minimally invasive perventricular device closure of ventricular septal defect in infants under transthoracic echocardiograhic guidance: Feasibility and comparison with transesophageal echocardiography. Cardiovasc Ultrasound. 2013;11(1):8. https://doi.org/10.1186/1476-7120-11-8
  • Xing Q, Wu Q, Shi L, et al. Minimally invasive transthoracic device closure of isolated ventricular septal defects without cardiopulmonary bypass: Long-term follow-up results. J Thorac Cardiovasc Surg. 2015;149(1):257-64. https://doi.org/10.1016/j.jtcvs.2014.07.078
  • Pedra CAC, Pedra SRF, Chaccur P, et al. Perventricular device closure of congenital muscular ventricular septal defects. Expert Rev Cardiovasc Ther. 2010;8(5):663-74. https://doi.org/10.1586/erc.10.31
  • Lifetechmed.com [Internet]. China: CeraTM Occluders. LifeTech Scientific Co., Available from: http://www.lifetechmed.com
  • Voitov A, Omelchenko A, Gorbatykh Y, et al. Outcomes of perventricular off-pump versus conventional closure of ventricular septal defects: A prospective randomized study. Eur J Cardio-thoracic Surg. 2017;51(5):980-986. https://doi.org/10.1093/ejcts/ezx002.
  • Li D, Zhou X, Li M, et al. Comparisons of perventricular device closure, conventional surgical repair, and transcatheter device closure in patients with perimembranous ventricular septal defects: A network meta-analysis. BMC Surg. 2020;20(1):115. https://doi.org/10.1186/s12893-020-00777-w
  • Lock J, Block P, De Wolf D, et al. Transcatheter closure of ventricular septal defects. Circ. 1988;78:2:361-68. https://doi.org/10.1161/01.cir.78.2.361
  • Pedra CAC, Pedra SRF, Esteves CA, et al. Percutaneous Closure of Perimembranous Ventricular Septal Defects with the Amplatzer Device: Technical and Morphological Considerations. Catheter Cardiovasc Interv. 2004;61(3) :403-10. https://doi.org/10.1002/ccd.10797
  • Knauth AL, Lock JE, Perry SB, et al. Transcatheter device closure of congenital and postoperative residual ventricular septal defects. Circulation. 2004;110(5):501-7. https://doi.org/10.1161/01.CIR.0000137116.12176.A6
  • Thakkar B, Patel N, Shah S, et al. Perventricular device closure of isolated muscular ventricular septal defect in infants: a single centre experience. Indian Heart J. 2012;64(6):559-67. https://doi.org/10.1016/j.ihj.2012.09.006
  • Schipper M, Slieker MG, Schoof PH, et al. Surgical Repair of Ventricular Septal Defect; Contemporary Results and Risk Factors for a Complicated Course. Pediatr Cardiol. 2017;38(2):264-270. https://doi.org/10.1007/s00246-016-1508-2
  • David LS, Brandi BS, Charles D F, et al. Ventricular septal defect. In: David DY, Luca AV, Stephen CY, editors. Congenital cardiac surgery. 3rd ed. New York: McGraw Hill Medical; 2014; p.65.
  • Huang XS, Luo ZR, Chen Q, et al. A comparative study of perventricular and percutaneous device closure treatments for isolated ventricular septal defect: A Chinese single-institution experience. Brazilian J Cardiovasc Surg. 2019;34(3):344–351. https://doi.org/10.21470/1678-9741-2018-0351
  • Adilbekova A, Marassulov S, Nurkeev B, et al. (2023). Mortality rates of ventricular septal defect for children in Kazakhstan: spatio - temporal epidemiological appraisal. Congenital Heart Disease. 2023;18(4); 447-459. https://doi.org/10.32604/chd.2023.028742
  • Adilbekova A., Marassulov S., Baigenzhin A., Kozhakhmetov S.et all. (2024). Hybrid Versus Traditional Method Closure of Ventricular Septal Defects in Children. JTCVS Techniques.
  • Ou-Yang W Bin, Wang SZ, Hu SS, et al. Perventricular device closure of perimembranous ventricular septal defect: Effectiveness of symmetric and asymmetric occluders. Eur J Cardio-thoracic Surg. 2017;51(3):478–482. https://doi.org/10.1093/ejcts/ezw352
  • Liu H, Lu FX, Zhou J, et al. Minimally invasive perventricular versus open surgical ventricular septal defect closure in infants and children: A randomised clinical trial. Heart. 2018;104(24):2035-2043. https://doi.org/10.1136/heartjnl-2017-312793
  • 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. https://doi.org/10.1186/s13019-020-1062-0
  • Huang JS, Huang ST, Sun KP, et al. Health-related quality of life in children and adolescents undergoing intraoperative device closure of isolated perimembranous ventricular septal defects in southeastern China. J Cardiothorac Surg. 2019;14(1):218. https://doi.org/10.1186/s13019-019-1040-6
  • Chen Q, Hong ZN, Zhang GC, et al. Intraoperative Device Closure of Isolated Ventricular Septal Defects: Experience on 1,090 Cases. Ann Thorac Surg. 2018;105(6):1797-1802. https://doi.org/10.1016/j.athoracsur.2018.02.059