Comparison of results and complications of surgical and Amplatzer device closure of atrial septal defects.
OBJECTIVE
Results and complications of surgical versus transcatheter treatment of atrial septal defect in the current era are compared.


METHODS
All consecutive patients with a secundum atrial septal defect and a pulmonary/systemic flow ratio of 1.5:1 or more who presented between May 1997 and June 1998 were enrolled in this study. All patients except those who initially had defects not feasible for interventional occlusion were catheterized to allow interventional closure of the defects. All patients in whom interventional closure could not be performed underwent surgical closure.


RESULTS
Sixty-one patients underwent surgery at a median age of 20 years (0.5-74 years) and 61 had the defect closed with an Amplatzer device (AGA Medical Corporation, Golden Valley, Minn) at a median age of 12 years (0.8-77.7 years) (P >.2). Hospital stay in surgically treated patients was 8 days (6-19 days) versus 3 days (3-14 days) in interventionally treated patients (P <.001). Atrial septal defect and shunt sizes were larger in the surgical group ( P <.001). Closure rates in the 2 groups were identical (98%). One patient (68 years) in the surgical group had a perforated duodenal ulcer that necessitated an operation 8 days after closure of the atrial septal defect, and 1 (26 years) had an infected lateral thoracotomy wound necessitating plastic surgery. Embolization of the Amplatzer device to the left ventricle was observed in 1 patient (29 years). The device could be retrieved from the heart, but vascular surgery was required to extract it from the femoral artery.


CONCLUSIONS
As complete closure rates and complications are identical, but duration of hospital stay is shorter with less morbidity, we prefer implantation of an Amplatzer septal occluder to surgery wherever possible.
Berger
F
F
Klinik für Angeborene Herzfehler und Klinik für Herz-, Thorax- und Gefässchirurgie, Deutsches Herzzentrum, Berlin, Germany. fberger@dhzb.de
Vogel
M
M
Alexi-Meskishvili
V
V
Lange
P E
PE
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001775:Blood Circulation / Q000502:physiology; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D004381:Duodenal Ulcer / Q000150:complications; D017548:Echocardiography, Transesophageal; D005263:Femoral Artery; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000209:etiology; D006321:Heart; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000150:complications; D019736:Prostheses and Implants / Q000009:adverse effects; D019919:Prosthesis Implantation / Q000009:adverse effects; D011652:Pulmonary Circulation / Q000502:physiology; D013530:Surgical Wound Infection / Q000209:etiology; D013908:Thoracotomy / Q000009:adverse effects; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional