Recent Experience and Follow-Up After Surgical Closure of Secundum Atrial Septal Defect in 120 Children

Abstract

While percutaneous catheter closure proves an effective treatment for secundum atrial septal defect (ASD2), some child patients require surgical closure. We assessed the risks associated with isolated surgical ASD2 closure by reviewing the outcomes of 120 children operated on between 1999 and 2011 (mean age 4.6 ± 3.9 years, mean weight 17 ± 12 kg). Direct sutures were performed in 4% and patch closures in 96%. The mean cardiopulmonary bypass duration was 38 ± 14 min, aortic cross-clamp time 19 ± 9 min, intensive care unit length of stay 1.6 ± 1.1 days, hospital stay 11.2 ± 5.1 days. There were no complications in 60 patients (50%) and major complications in 8 (6.7%), with 1 patient (0.8%) dying of pneumonia-induced sepsis, 2 (1.7%) requiring revision surgery, 3 (2.5%) requiring invasive treatment (2 pericardial drainage, 1 successful resuscitation), and 2 (1.7%) presenting thromboembolisms (1 cerebral stroke, 1 cardiac thrombus). In hospital minor complications occurred in 22 patients: 17 pericardial effusions (15%), 15 infections requiring treatment (12.5%), 1 sternal instability (0.8%), 4 anemias requiring transfusion (3.3%), 7 pulmonary atelectasis (6%), and 2 post-extubation glottis edema (1.7%). At early outpatient follow-up, complications occurred in 21 patients: 16 (13.3%) pericardial effusions, 4 (3.3%) infections requiring treatment, and 3 (2.5%) keloid scarring. No complications occurred during long-term follow-up. In line with published data, mortality was low (0.8%), yet major complications (6.7%) were more common in these cases than those following percutaneous ASD2 closure. Minor complications were frequent (43%) with no long-term sequelae.

Outcomes Following Closure of Secundum Atrial Septal Defect in Children ≤ 15 kg in a French Tertiary Centre

“…There was no mortality in both groups. This is in accordance with previous reports in the current era [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. There was a significant higher rate of periprocedural complications between the two groups (40% in group A versus 4.5% in group B, p = 0.0054) due to a significantly higher rate of minor complications in group A compared to group B ( Table 4 ).…”

“…In our series, the rate of major complications is 8%, which is similar to that of previously published studies, including a meta-analysis with 1270 patients that reported a 6.8% rate of adverse events [ 14 ], although our patients were smaller in terms of age and weight. No major complication occurred in the transcatheter group before discharge and during follow-up, which is in line with other studies [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. One patient had a per-procedural transient atrio-ventricular block, which resolved spontaneously after the device was resized.…”

“…The success rates in both groups and immediate residual shunt after surgical closure are similar to those of other studies [ 11 , 12 , 13 , 14 , 15 ]. Our rate of immediate residual shunt in the transcatheter group was higher compared to the previous nationwide cohort study of sASD closure in children [ 11 ] and other studies in children ≤ 15 kg [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ].…”

“…Our results about the surgical closure of sASD are also consistent with the available literature in terms of complications. The total rate of reported complications in various studies ranges from 31 to 68%, with a proportion of major complications varying from 4 to 16% [ 12 , 13 , 14 , 15 , 16 , 25 , 26 , 27 , 28 , 29 ]. In our series, the rate of major complications is 8%, which is similar to that of previously published studies, including a meta-analysis with 1270 patients that reported a 6.8% rate of adverse events [ 14 ], although our patients were smaller in terms of age and weight.…”

Pericardial effusion after congenital heart surgery

“…In recent studies, the incidence of PE after ASD repair was 27.5% to 37.1%, with 1.7% to 2.1% of the patients having severe PE requiring drainage. 21 , 22 Elias and colleagues 2 surmised that an inflammatory reaction secondary to pericardiotomy and right atriotomy combined with chronic volume overload in the right heart may play a role in PE production after surgical ASD repair, although the pathomechanism is still unclear. In the present study, the incidence of relatively severe PE after ASD repair was 1.1% (69/6105 cases), which was similar to that reported by other researchers.…”