Abstract
Background
Transcatheter closure has been widely used for the treatment of ventricular septal defect (VSD) in children. However, post-procedural hemolysis remains a clinically relevant complication, and its underlying mechanisms and risk factors have not been systematically investigated.
Methods
In this single-center retrospective cohort study, children who underwent transcatheter VSD closure at the Children's Hospital of Chongqing Medical University between June 2015 and June 2024 were included. Perioperative clinical data were collected. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors. A prediction model was subsequently developed based on the selected variables and internally validated using bootstrap resampling with optimism correction.
Results
Among 1,427 children who underwent transcatheter VSD closure, hemolysis occurred in 53 cases, yielding an incidence of 3.7%. After exclusions for missing key variables, a cohort of 196 patients (including all 53 hemolysis cases) was used for model development. Multivariable analysis identified occluder diameter, age, residual shunt, and pulmonary valve flow velocity as independent risk factors for post-procedural hemolysis. The model demonstrated good discrimination in the derivation cohort, with an apparent AUC of 0.914 and a bootstrap-corrected AUC of 0.913 (95% CI: 0.865–0.956). Calibration was also satisfactory according to the Hosmer–Lemeshow test. Decision curve analysis demonstrated a net clinical benefit across a threshold probability range of 0%–50%.
Conclusions
Occluder diameter, age, residual shunt, and pulmonary valve flow velocity were identified as independent risk factors for hemolysis after transcatheter VSD closure in children. The developed model showed good discrimination and calibration and may serve as a useful tool for preprocedural risk stratification and postprocedural surveillance. Further external validation and prospective evaluation are warranted.