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

Abstract

ObjectivesAtrial Septal Defect (ASD) accounts for 10% of congenital cardiac defects. The purpose of this retrospective study was to compare the short-term outcomes of surgical versus trans catheter closure of secundum atrial septal defect.MethodsThis is a single-center retrospective cohort study in patients who had surgical or trans catheter ASD closure. ASD closure outcomes such as hospital cost, length of hospital and ICU stay, residual ASDs, complications, readmission, hospital and three month mortality were recorded and compared.ResultsBetween March 2010 and March 2016, total of 102 secundum ASD patients were treated in our center (71 patients surgical ASD closure and 31 patients trans catheter ASD closure). About 13.9% of patients (5/36) in the device group had failed procedural attempt for various reasons and these patients underwent surgery closure. Complete closure was observed in 26 of 31 patients (83.9%) in the device group and in 70 of 71 patients in the surgery group (98.6%). The mean length of hospital stay was 5.56 days for surgical group and 2.06 days for device group. The procedure cost for surgery was found to be 5.7% lower than trans catheter closure (patient payment). The complication rates were 18.3% for surgical group and 25.8% for the device group. Readmission after discharge was more common in surgery group (11.2 vs 6.4%). Hospital and three months mortality in both groups were zero.ConclusionsBoth trans catheter and surgical procedure are good methods of successful ASD closure. Considering that the surgical group patients were higher risk patients, mean total hospital cost of patient's procedures were significantly higher in device closure group, failed intervention rate and residual ASD were more common in device group and complications of device group were more serious; thus, appropriate patient selection is an important factor for successful device closure.

Outcomes after ASD Repair in Adulthood : Surgical Closure vs Percutaneous Device Closure

“…They also observed no displacement of the device [9]. Despite the same success rate in other findings, another study found that surgical closure of ASD is more likely to close wholly compared to patients who underwent the device group [10]. Incomplete closure of ASD in device groups might progress into pulmonary hypertension and additional procedure in the future [10].…”

“…However, there were slightly different outcomes between surgery or device approach in adulthood for atrial septal defect closure. The study conducted by three different researchers in different settings stated that surgery closure was related to more extended hospital stay compared to percutaneous closure [6], [7], [10]. According to a study by Askari, the longer duration of hospital stay was due to higher-risk patients indicated for surgery closure rather than percutaneous [10].…”

“…The study conducted by three different researchers in different settings stated that surgery closure was related to more extended hospital stay compared to percutaneous closure [6], [7], [10]. According to a study by Askari, the longer duration of hospital stay was due to higher-risk patients indicated for surgery closure rather than percutaneous [10]. In addition, the prolonged hospital stay was caused by the need to be closely monitored after the surgery [14].…”

“…Askari [10] 102 patients with a history of secundum atrial septal defect were included in their studies.…”

Pediatric Cardiac Service Development Programs for Low- and Middle-Income Countries in Need of Improving or Initiating Local Services

“…Another consideration to be addressed are the societal and cultural implications of surgical scars especially in the female patients. Where applicable and safe, transcatheter repair of some defects may be the procedure of choice (51–53).…”