Optimized retrograde approach and device selection with Konar-MF™ for pediatric transcatheter ventricular septal defect closure.

Abstract

Background: This study aims to evaluate the mid-term outcomes of transcatheter ventricular septal defect closure with the Konar-MF™ device and to investigate the impact of an optimized device selection strategy using a retrograde approach.

Methods: Between January 2019 and November 2023, a total of 58 patients (32 males, 26 females; median age: 4.5 years; range, 8 months to 16 years) who underwent transcatheter closure of ventricular septal defects using the Konar-MF™ device were retrospectively analyzed. Patient demographics, procedural details, and follow-up data were recorded.

Results: Procedural success was achieved in 95% of cases, with a median procedure time of 60 min and fluoroscopy time of 12.6 min. Retrograde implantation was used in 79% of patients, significantly reducing procedural time and minimizing complications associated with an arteriovenous loop. Our refined strategy of selecting smaller devices when anatomically feasible played a crucial role in reducing interference with surrounding cardiac structures, substantially contributing to the absence of complete atrioventricular block in our cohort. Major complications included device embolization, moderate aortic regurgitation due to device dislocation, and right ventricular perforation (each in 1.8% of patients). The median follow-up was 34.5 months. Residual shunt rates were initially 42% on postoperative Day 1, reducing to 1.8% by the end of the follow-up period.

Conclusion: The Konar-MF™ occluder demonstrated high procedural success and acceptable complication rates for perimembranous ventricular septal defect closure. The use of a retrograde approach and a refined device selection strategy were key factors in achieving favorable outcomes, minimizing complications such as atrioventricular block and valve interference. The device offers significant advantages, making it a suitable alternative to surgical ventricular septal defect closure.