Comparison of Atrial Septal Defect Closure Using Amplatzer Septal Occluder with Surgery

Abstract

Our study reports the results of a comparison of closure of atrial septal defect (ASD) surgically with transcatheter closure using the Amplatzer septal occluder. Patients having an ASD and a surgical closure or transcatheter closure between January 1999 and July 2000 were selected. There were 103 patients who had ASD. All 64 patients in group 1 (surgery) had a successful operation, with only 2 patients with a mild residual shunt. There were 39 patients enrolled for transcatheter closure of the ASD (group 2). Four patients were excluded initially. The median age for group 1 was 25 years (range 2.3-64 years) compared to 11.7 years (range 2-69 years) in group 2 (p = 0.035). In group 1, the mean ASD diameter measured was 28.4 +/- 10.2 mm compared to 23.4 +/- 5.7 mm in group 2 (p = 0.003). In 29 patients, devices were deployed with sizes from 10 mm to 30 mm (median 24 mm). Three patients were excluded because a larger device (>30 mm) was not available and devices were not successfully deployed in another 3 patients. One patient had a device embolized into the right ventricle (surgical removal and closure of the ASD). Complications occurred in 13 patients in group 1 and 4 patients in group 2. Complete occlusion occurred in 27 of 28 group 2 patients (96.4%) during the follow-up period (10.2 +/- 5.4 months). The Amplatzer septal occluder is a new device for closure of different-sized ASDs. The intermediate-term follow-up demonstrated excellent closure results. The benefit for each patient was demonstrated in less morbidity and less time spent in the hospital.

Comprehensive evaluation of atrial septal defects in individuals undergoing percutaneous repair by 64-detector row computed tomography

“…Catheter guided ASD repair is preferred over the open surgical alternative because of decreased morbidity and mortality without the sacrifice of efficacy [1][2][3][4]. The success of the procedure is reliant upon proper patient selection.…”

“…Transcatheter atrial septal defect (ASD) closure has been demonstrated to be safe, efficacious and associated with lower morbidity and cost when compared to surgical closure [1][2][3][4]. However, procedural success is predicated on proper patient selection for which accurate non-invasive imaging assessment is paramount.…”

Assessment of right atrial and right ventricular size in children after percutaneous closure of secundum atrial septal defect with Amplatzer septal occlude

“…After multicentre clinical trials, the device was approved by the United States Food and Drug Administration (FDA) in 2002 for use in children and adults. For transcatheter closure using the Amplatzer septal occluder, additional criteria are that the ASD II diameter is not excessively large for currently available devices, and there should be a distance of>5 mm from the margins of the defect to the coronary sinus, atrioventricular valves and right upper pulmonary vein [4, 5]. The contraindications for percutaneous closure include too big defect or too small surrounding rims (except for the anterior rim toward the aorta).…”

Surgical Versus Percutaneous Occlusion of Ostium Secundum Atrial Septal Defects

“…Mean CPB time and mean aortic cross-clamp time were standard for this procedure (14,24). Residual early and late atrial shunts after surgical closure were rare (32,33).…”