title: Surgery for complications of trans-catheter closure of atrial septal defects: a multi-institutional study from the European Congenital Heart Surgeons Association.
abstract: 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.
authors.affiliation: Mitera Children's and Hygeia Hospitals, Marousi, Athens, Greece. gsarris@mac.com
authors.forename: George E
authors.initials: GE
authors.lastname: Sarris
authors.forename: George
authors.initials: G
authors.lastname: Kirvassilis
authors.forename: Prodromos
authors.initials: P
authors.lastname: Zavaropoulos
authors.forename: Emre
authors.initials: E
authors.lastname: Belli
authors.forename: Hakan
authors.initials: H
authors.lastname: Berggren
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.forename: Juan V
authors.initials: JV
authors.lastname: Comas
authors.forename: Antonio F
authors.initials: AF
authors.lastname: Corno
authors.forename: Willem
authors.initials: W
authors.lastname: Daenen
authors.forename: Duccio
authors.initials: D
authors.lastname: Di Carlo
authors.forename: Tjark
authors.initials: T
authors.lastname: Ebels
authors.forename: Jose
authors.initials: J
authors.lastname: Fragata
authors.forename: Leslie
authors.initials: L
authors.lastname: Hamilton
authors.forename: Viktor
authors.initials: V
authors.lastname: Hraska
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jacobs
authors.forename: Stojan
authors.initials: S
authors.lastname: Lazarov
authors.forename: Constantine
authors.initials: C
authors.lastname: Mavroudis
authors.forename: Dominique
authors.initials: D
authors.lastname: Metras
authors.forename: Jean
authors.initials: J
authors.lastname: Rubay
authors.forename: Christian
authors.initials: C
authors.lastname: Schreiber
authors.forename: Giovanni
authors.initials: G
authors.lastname: Stellin
mesh_terms: 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