Percutaneous versus surgical closure of secundum atrial septal defect: comparison of early results and complications.
BACKGROUND
Surgical closure of atrial septal defect (ASD) provides excellent results. Given the increasing popularity of percutaneous techniques, a comparison between the 2 methods is needed.


METHODS
Between December 1988 and June 2003, we performed 1284 procedures in 1268 consecutive patients with isolated secundum ASD. Five hundred and thirty-three patients underwent surgical repair of ostium secundum ASD (group A). Seven hundred and fifty-one consecutive patients underwent percutaneous ASD closure (group B). The following outcomes were studied: mortality, morbidity, hospital stay, and efficacy.


RESULTS
There were no postoperative deaths. The overall rate of complications was higher in group A than in group B: 44% (95% CI 39.8%-48.2%) versus 6.9 % (95% CI 5%-8.7%) (P < .0001). Major complications were also more frequent in group A: 16% (95% CI 13%-19%) versus 3.6% (95% CI 2.2%-5.0%) (P = .002). Multiple logistic regression analysis showed that surgery was independently strongly related to the occurrence of total complication (odds ratio [OR] 8.13, 95% CI 5.75-12.20) and of major complications (OR 4.03, 95% CI 2.38-7.35). The occurrence of minor complications was independently related to surgery (OR 7.33, 95% CI 4.75-11.02), childhood (OR 1.52, 95% CI 1.01-2.34), and presence of systemic hypertension (OR 1.35, 95% CI 1.01-4.41). Hospital stay was shorter in group B (3.2 +/- 0.9 vs 8.0 +/- 2.8 days, P < .0001).


CONCLUSIONS
Percutaneous ASD closure provides, in experienced hands and in highly specialized centers, excellent results with a lower complication rate and requires a shorter stay in hospital.
Butera
Gianfranco
G
Pediatric Cardiology, Istituto Policlinico San Donato, San Donato Milanese (MI), Italy. gianfra.but@lycos.com
Carminati
Mario
M
Chessa
Massimo
M
Youssef
Rana
R
Drago
Manuela
M
Giamberti
Alessandro
A
Pomè
Giuseppe
G
Bossone
Edoardo
E
Frigiola
Alessandro
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors