Аңдатпа
Background: The hybrid technique for ventricular septal defect (VSD) closure combines elements of conventional open-heart surgery with cardiopulmonary bypass (CPB) and minimally invasive approaches, including beating-heart occluder implantation through right ventricular free-wall puncture. Hybrid periventricular VSD closure offers several advantages over CPB-based surgery. Its less invasive nature, facilitated by catheter-based access to the defect, may reduce anesthesia duration and hospital stay in pediatric patients. Despite these potential benefits, the adoption of hybrid VSD correction remains limited, particularly in Kazakhstan. Methods: We report our experience with hybrid VSD closure in 747 pediatric patients (age range: 0-18 years) treated between 2016 and 2024, representing the first implementation of this technique in Kazakhstan. We evaluated the impact of pre-, peri-, and postoperative variables, including VSD size and type, occluder characteristics, duration of anesthesia, and mechanical ventilation, on the risk of early or late rhythm disturbances and the need for conversion to CPB. Results: Postoperative complications occurred in 27 of 747 patients. Seven patients developed early transient rhythm disturbances, 10 experienced complete atrioventricular block (cAVB) between 2 weeks and 3.5 years after surgery, and 8 required conversion to CPB. Early transient rhythm disturbances were not associated with any analyzed factors. In contrast, late cAVB was significantly associated with older age (>5 years) and larger VSD size (>8 mm). Inlet VSD morphology, larger VSD size, and their combination were significant predictors of CPB conversion. Based on these findings, we propose an algorithm for patient selection for minimally invasive hybrid VSD closure. Conclusions: Several clinical and anatomical factors should be considered when assessing perioperative and long-term risks of hybrid VSD closure in pediatric patients. Nevertheless, the hybrid approach represents a valuable alternative to conventional surgery, demonstrating a low incidence of long-term complications.