title: Safety and feasibility of intra-operative device closure of atrial septal defect with transthoracic minimal invasion.
abstract: OBJECTIVE
  The study aims to evaluate the safety and feasibility of intra-operative device closure of atrial septal defect with transthoracic minimal invasion.
  
  
  METHODS
  From May 2006 to June 2009, 252 patients with secundum-type atrial septal defect closure were enrolled in our institution. The patients were divided into two groups, with 182 patients in group I with intra-operative device closure and 72 in group II with surgical closure. In group I, the patients' age ranged from 3 months to 62 years (mean±standard deviation, 19.0±16.7 years). This approach involved a transthoracic minimal invasion that was performed after full evaluation of the atrial septal defect by transthoracic echocardiography, deploying the device through the delivery sheath to occlude the atrial septal defect.
  
  
  RESULTS
  In group I, 180 patients were occluded successfully under this approach. The size of the occluder device implanted ranged from 6 to 48 mm. Minor complications occurred, which included transient arrhythmias (n=23) and pleural effusion (n=15). Two patients with postoperative cardiac arrest were successfully cardiopulmonary resuscitated. Another two patients with occluder dislodged back into the right atrium were turned to surgical repair with cardiopulmonary bypass on the postoperative day. In group II, all patients were occluded successfully, and almost all patients needed blood transfusion and suffered from various minor complications. All discharged patients were followed up for 1-5 years. During this period, we found no recurrence, no thrombosis, even no device failure. In our comparative studies, group II had significantly longer intensive care unit (ICU) stay and hospital stay than group I (p<0.05). The cost for group I was less than group II (p<0.05).
  
  
  CONCLUSIONS
  Intra-operative device closure of atrial septal defect with transthoracic minimal invasion is a safe and feasible technique. It had the advantages of cost savings, yielding better cosmetic results, and leaving less trauma than surgical closure.
authors: Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, PR China.
authors: Qiang
authors: Q
authors: Chen
authors: Hua
authors: H
authors: Cao
authors: Gui-Can
authors: GC
authors: Zhang
authors: Liang-Wan
authors: LW
authors: Chen
authors: Dao-Zhong
authors: DZ
authors: Chen
references: Ann Thorac Surg. 2006 Apr;81(4):1417-9
references: 16564284
references: J Am Coll Cardiol. 2001 May;37(6):1707-12
references: 11345388
references: J Card Surg. 2009 Mar-Apr;24(2):181-4
references: 19267827
references: Clin Cardiol. 2008 Jan;31(1):24-7
references: 18203115
references: Eur J Cardiothorac Surg. 2008 Jun;33(6):1055-60
references: 18430580
references: Br Heart J. 1981 Jul;46(1):55-62
references: 7272113
references: Circulation. 1996 Feb 1;93(3):502-12
references: 8565168
references: Echocardiography. 2006 Oct;23(9):763-70
references: 16999695
references: Arch Dis Child. 1981 Oct;56(10):784-6
references: 7305418
references: Chin Med J (Engl). 2008 Jun 5;121(11):973-6
references: 18706243
references: J Chin Med Assoc. 2008 Aug;71(8):399-405
references: 18772119
references: Am J Cardiol. 2004 Jul 15;94(2):256-60
references: 15246918
references: Asian Cardiovasc Thorac Ann. 2007 Jun;15(3):191-3
references: 17540985
references: Curr Interv Cardiol Rep. 2000 Aug;2(3):274-282
references: 11096677
references: Heart. 1999 Sep;82(3):300-6
references: 10455079
references: J Thorac Cardiovasc Surg. 2011 Mar;141(3):631-6
references: 21236449
references: J Thorac Cardiovasc Surg. 2007 Oct;134(4):946-51
references: 17903512
references: Ann Thorac Surg. 2010 Apr;89(4):1250-4
references: 20338346
references: Ultrasound Med Biol. 2009 Jan;35(1):58-64
references: 18718698
references: Am J Cardiol. 2002 Oct 15;90(8):865-9
references: 12372575
references: J Am Coll Cardiol. 2006 Jan 17;47(2):326-31
references: 16412855
references: Ann Thorac Surg. 2003 May;75(5):1532-4
references: 12735575
references: Heart Surg Forum. 2007;10(2):E125-8
references: 17597035