Transcatheter closure of perimembranous ventricular septal defects using a novel wire-maintaining technique.

OBJECTIVES: We aimed to evaluate the clinical feasibility and safety of a novel wire-maintaining technique (WMT) for transcatheter closure of perimembranous ventricular septal defects (PmVSDs). BACKGROUND: Transcatheter device closure of PmVSDs has been increasingly performed and this procedure is now offered as primary therapy at many institutions. METHODS: A total of 103 patients with complex PmVSDs were randomized to either the conventional technique (CT) group (n = 51) or the WMT group (n = 52). In the CT group, the track wire was withdrawn before the occluder insertion and deployment. If inappropriate, the initial occluder was withdrawn and the "arteriovenous wire loop" was re-established. In the WMT group, the track wire was maintained in the delivery sheath during the procedure. If the initial occluder was inappropriate, the delivery sheath could be reintroduced over the maintained wire. RESULTS: For those patients who could not achieve optimal results with the initially selected occluders and required further device replacement, the procedure and fluoroscope time was reduced significantly in the WMT group compared with the CT group ([50.8 +/- 13.2] min vs. [61.5 +/- 15.4] min, P < 0.01 and [21.6 +/- 8.6] min vs. [27.3 +/- 7.4] min, P < 0.05; respectively). There was no difference in the incidence of complications of two groups. CONCLUSIONS: The WMT was feasible and safe for the transcatheter treatment of PmVSDs, especially for those complex defects with great challenge. Using this novel technique, the reconstruction of "arteriovenous wire loop" could be avoided in patients requiring device replacement.