Comparison of Clinical Outcomes After Transcatheter vs. Minimally Invasive Cardiac Surgery Closure for Atrial Septal Defect

Abstract

nickel allergy. 6, 7 Technological advances have made contemporary surgery less invasive than classical surgery using full sternotomy. Cardiac surgery performed without full sternotomy is called minimally invasive cardiac surgery (MICS). 8 Advantages of MICS are swift recovery and reduction of pain and sternal wound infection. Furthermore, it is cosmetically appealing, considering the higher prevalence of women and the relatively young population of patients with ASD compared with the typical surgical population. 9 MICS for ASD has been shown to be a safe procedure with satisfactory long-term outcomes. 10,11 More recently, MICS has used endoscopy through a small skin incision in the right chest wall, and is called a right mini-thoracotomy MICS. 12 The aim of this study was to compare percutaneous closure with right mini-thoracotomy MICS for secundum ASD because to date, no direct comparison has been made in terms of efficacy and safety. We also report data on the S ecundum atrial septal defect (ASD) is one of the most common congenital cardiac malformations. 1 Guidelines recommend closure of ASD in patients with right ventricular enlargement, regardless of symptoms. 2 Surgical closure was performed for the first time in 1953 and has been the gold standard for decades. Percutaneous ASD closure, on the other hand, was introduced in 1975. 3 In 2002, a non-randomized multicenter study compared percutaneous closure with surgery, and demonstrated comparable success rates. Notably, minor complication rates were significantly higher with surgery than with percutaneous closure, and the hospital stay was shorter with percutaneous closure. 4 Percutaneous closure has been widely performed and has replaced surgery, except in cases of large defects, insufficient rims, or a left atrium too small to accommodate a device. 2,5 However, concern remains regarding the requirement for prosthetic device implantation, which could eventually lead to delayed complications such as cardiac erosion, device thromboembolic events and Conclusions: Percutaneous closure and MICS had high success rates without deaths. For ASD patients with a suitable anatomy, percutaneous closure can be considered as the first therapeutic option.

Short-term outcomes after surgical versus trans catheter closure of atrial septal defects; a study from Iran

“…The patients with more than moderate and persistent tricuspid insufficiency after ASD closure have poor prognosis 22, 23. In our 7 patients with more than moderate TR that underwent TV Repair, tricuspid regurgitation severity became trivial to mild in postoperative period.…”

Minimally invasive versus transcatheter closure of secundum atrial septal defects: a systematic review and meta-analysis

“…Patients were assessed immediately after and during follow-ups using colour Doppler flow imaging. 22 Aside from Kodaira et al 23 shunts were reported in 1180 adults across five studies (Table 3). [20][21][22]24,25 The studies are separated based on children or adults, with an overall risk ratio of a resulting minor residual shunt displayed (RR = 6.04, 95% CI 1.69-21.63 in favour of MIS approach, I 2 = 39.0%) (Figure 4).…”

“…The characteristics of the six included studies are summarised in Table 1. [20][21][22][23][24][25] It is worth noting that the studies were all single centred and had a variable mean patient age. This difference in mean ages was accounted for during data analysis.…”

“…Peri-operative and post-operative characteristics are demonstrated in Tables 2 and 3. [20][21][22][23][24][25]…”

“…The LOHS was reported for 1534 adults and 93 children across the studies (Table 3). [20][21][22][23][24][25] Schneeberger et al 25 reported only the LOHS for MIS, hence it was excluded. The overall effect estimate suggests that the TC repair has a lower LOHS regardless of the age of patient (MD = 3.32 days, 95% CI 1.04-5.60).…”