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Background: This systematic review and meta-analysis aimed at comparing the midterm outcomes of perventricular device closure (PDC) with conventional surgical repair (CSR) for VSD., Methods: PubMed, Cochrane Library, and Web of Science databases were searched from January 1, 2005, to October 15, 2020, for English or Chinese language studies comparing outcomes of PDC with CSR for VSD. The midterm results were assessed as a primary outcome. A systematic review and meta-analysis was performed under the frequentist frame with risk ratio (RR) and 95% confidence interval (CI)., Results: A total of 4381 patients (PDC = 2016, CSR = 2365) from 15 studies were included. The pooled estimates of success rate favored the CSR compared with the PDC (RR, 0.97; 95% CI, 0.96 to 0.99; p = 0.001). No significant differences in minor complications or severe complications were found between the PDC and CSR (RR, 0.79; 95% CI, 0.50 to 1.23; p = 0.29; RR, 1.43; 95% CI, 0.74 to 2.75; p = 0.29). The pooled estimates of residual shunts favored the PDC compared with the CSR (RR, 9.07; 95% CI, 4.77 to 17.24; p < 0.001), the pooled estimates of aortic regurgitation favored the CSR compared with the PDC (RR, 1.59; 95% CI, 1.05 to 2.39; p = 0.03)., Conclusions: PDC is a safe and effective procedure with less surgical injury and shorter perioperative hospital stay. However, aortic regurgitation is a concern during follow-up., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2022 The Author(s). Published by IMR Press.)

Background: Recent developments in surgical techniques and hospital care have led to improved outcomes following repair of total anomalous pulmonary venous connection (TAPVC). However, surgical repair of neonatal TAPVC remains associated with a high risk of postoperative mortality and pulmonary venous obstruction (PVO). We conducted this retrospective study to identify risk factors associated with surgical outcomes in the neonatal population. Methods: A retrospective review was conducted for all 127 neonates who underwent operations for isolated TAPVC from January 2009 to January 2019. Results: Preoperative PVO occurred in 33 (26.0%) of the 127 patients. Fifty patients (39.4%) required tracheal intubation before the operation. Twenty-three patients (18.1%) underwent emergency surgery. There were 11 (8.7%) early deaths. Significant risk factors were prolonged cardiopulmonary bypass (CPB) time ( p = 0.013) and increased postoperative central venous pressure (CVP, p = 0.036). There were 5 (4.3%) late deaths within 1 year of repair. The risk factors for overall death were preoperative acidosis ( p = 0.001), prolonged CPB time ( p < 0.001) and increased postoperative CVP ( p = 0.007). In particular, mortality was significantly higher ( p = 0.007) with a postoperative CVP > 8 mmHg. With an increase in use of sutureless techniques ( p = 0.001) and decrease in deep hypothermic circulatory arrest ( p = 0.009) over the past 5 years, postoperative mortality greatly decreased (21.2%: 6.7%, p = 0.016). Postoperative PVO occurred in 15 patients (11.8%). Risk factors were mixed TAPVC ( p = 0.037), preoperative acidosis ( p = 0.001) and prolonged CPB time ( p = 0.006). Conclusion: Although postoperative mortality of neonatal TAPVC has dropped to 6.7% over the past 5 years, it is still relatively high. Risk factors for postoperative death include preoperative acidosis, prolonged CPB time and increased postoperative CVP. Mortality was significantly higher for neonates with an average CVP > 8 mmHg 24 h after surgery., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Ji, Qiu, Liu, Xie, Liufu, Liu, Chen, Wen, Li, Cen and Zhuang.)