title: Intraoperative device closure of atrial septal defects in the older population.
abstract: OBJECTIVE
  This study sought to prove the safety and feasibility of intraoperative device closure of atrial septal defect (ASD) with transthoracic minimal invasion in the older patients.
  
  
  METHODS
  From January 2006 to December 2009, 47 patients aged 50 years or more and suffered from atrial septal defect were enrolled in our institution. Patients were divided into two groups, 27 of which in group I with intraoperative device closure and the other 20 in group II with surgical closure. In group I, the method involved a minimal intercostal incision, which was performed after full evaluation of the atrial septal defect by transthoracic echocardiography, and the insertion of the device through the delivery sheath to occlude the atrial septal defect.
  
  
  RESULTS
  In group I, implantation was ultimately successful in all patients. The complete closure rate at 24 hours and 1 year were 81.5% and 100% respectively. In 6 of 27 patients, minor complications occurred: transient arrhythmia (n = 5) and blood transfusion (n = 3). In group II, all patients were closured successfully; almost all of them needed blood transfusion and suffered from various minor complications though. During a follow-up period of 1 to 5 years, no residual shunt, noticeable mitral regurgitation, significant arrhythmias, thrombosis, or device failure were found. In our comparative studies, group II had significantly longer ICU stay and hospital stay than group I (p < 0.05). The cost of group I was less than that of group II(p < 0.05).
  
  
  CONCLUSIONS
  Minimally invasive transthoracic device closure of the atrial septal defect at advanced age with a domestically made device without cardiopulmonary bypass is safe and feasible under transthoracic echocardiographic guidance. It was cost-savings, yielding better cosmetic results and leaving fewer traumas than surgical closure. Early and mid-term results are encouraging. However, it is necessary to evaluate the long-term results.
authors.affiliation: Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, PR China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Chen
authors.forename: Liang-Wan
authors.initials: LW
authors.lastname: Chen
authors.forename: Hua
authors.initials: H
authors.lastname: Cao
authors.forename: Gui-Can
authors.initials: GC
authors.lastname: Zhang
authors.forename: Dao-Zhong
authors.initials: DZ
authors.lastname: Chen
mesh_terms: D000368:Aged; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D055989:Septal Occluder Device; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome