Surgery for complications of trans-catheter closure of atrial septal defects: a multi-institutional study from the European Congenital Heart Surgeons Association.
OBJECTIVE
This study aims to analyse the collective experience of participating European Congenital Heart Surgeons Association centres in the surgical management of complications resulting from trans-catheter closure of atrial septal defects (ASDs).


METHODS
The records of all (n=56) patients, aged 3-70 years (median 18 years), who underwent surgery for complications of trans-catheter ASD closure in 19 participating institutions over a 10-year period (1997-2007) were retrospectively reviewed. Risk factors for surgical complications were sought. Surgical outcomes were compared with those reported for primary surgical ASD closure in the European Association of Cardio-thoracic Surgery Congenital Database.


RESULTS
A wide range of ASD sizes (5-34mm) and devices of various types and sizes (range 12-60mm) were involved, including 13 devices less than 20mm. Complications leading to surgery included embolisation (n=29), thrombosis/thrombo-embolism/cerebral ischaemia or stroke (n=12), significant residual shunt (n=12), aortic or atrial perforation or erosion (n=9), haemopericardium with tamponade (n=5), aortic or mitral valve injury (n=2) and endocarditis (n=1). Surgery (39 early emergent and 17 late operations) involved device removal, repair of damaged structures and ASD closure. Late operations were needed 12 days to 8 years (median 3 years) after device implantation. There were three hospital deaths (mortality 5.4%). During the same time period, mortality for all 4453 surgical ASD closures reported in the European Association of Cardio-Thoracic Surgery Congenital Database was 0.36% (p=0.001).


CONCLUSIONS
Trans-catheter device closure of ASDs, even in cases when small devices are used, can lead to significant complications requiring surgical intervention. Once a complication leading to surgery occurs, mortality is significantly greater than that of primary surgical ASD closure. Major complications can occur late after device placement. Therefore, lifelong follow-up of patients in whom ASDs have been closed by devices is mandatory.
Sarris
George E
GE
Mitera Children's and Hygeia Hospitals, Marousi, Athens, Greece. gsarris@mac.com
Kirvassilis
George
G
Zavaropoulos
Prodromos
P
Belli
Emre
E
Berggren
Hakan
H
Carrel
Thierry
T
Comas
Juan V
JV
Corno
Antonio F
AF
Daenen
Willem
W
Di Carlo
Duccio
D
Ebels
Tjark
T
Fragata
Jose
J
Hamilton
Leslie
L
Hraska
Viktor
V
Jacobs
Jeffrey
J
Lazarov
Stojan
S
Mavroudis
Constantine
C
Metras
Dominique
D
Rubay
Jean
J
Schreiber
Christian
C
Stellin
Giovanni
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D004630:Emergencies; D004812:Epidemiologic Methods; D005060:Europe / Q000453:epidemiology; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D011183:Postoperative Complications / Q000601:surgery; D055989:Septal Occluder Device / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult