Long-term outcomes of device closure of very large secundum atrial septal defects: a comparison of transcatheter vs intraoperative approaches.
BACKGROUND
Transcatheter device closure (TCDC) and intraoperative device closure (IODC) have emerged as minimally invasive methods in the treatment of secundum atrial septal defects (ASDs), but the long-term safety and efficacy remains uncertain for the large ASDs.


OBJECTIVE
TCDC may be as safe and efficacious as IODC for closure of large ASDs in terms of long-term clinical outcomes.


METHODS
Ninety-two patients who had ASDs with a defect diameter of ≥30 mm were included in this study. The patients received either TCDC (n = 42) or IODC (n = 50). An Amplatzer septal occluder was used in both groups. The dumbbell-like device deploying technique was introduced in the TCDC group. Physical exams, electrocardiography, and echocardiography were performed preprocedurally and postprocedurally at the index follow-up visits.


RESULTS
The procedural immediate success rate was 97.6% for TCDC and 98.0% for IODC (P = 0.328). The rate of periprocedural complications was 9.5% for TCDC and 28.0% for IODC (P = 0.026). The mean hospital stay was 7.5 ± 2.7 days for TCDC and 11.9 ± 3.8 days for IODC (P < 0.001). For the mean follow-up of 5.4 ± 0.5 years, there were no cardiac deaths and late complications in either group. No significant residual shunts were documented, and symptoms were significantly improved in both groups. Right and left ventricular diameter, pulmonary artery diameter, and pulmonary systolic pressure were all significantly decreased in both groups (P < 0.05).


CONCLUSIONS
The present study confirmed the long-term safety and efficacy for closing a large ASD either by TCDC or IODC. Either of them could become an effective alternative to the surgery for large ASD closure. The authors have no funding, financial relationships, or conflicts of interest to disclose.
Department of Cardiology, Union Hospital, Fujian Medical University and Fujian Institute of Coronary Artery Disease, Fuzhou, China.
Jin-Jian
JJ
Guo
Yu-Kun
YK
Luo
Zhao-Yang
ZY
Chen
Hua
H
Cao
Xiao-Ping
XP
Yan
Hua
H
Chen
Ya-Fei
YF
Peng
Chao-Gui
CG
Lin
Liang-Long
LL
Chen
D000328:Adult; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012449:Safety; D055989:Septal Occluder Device; D013223:Statistics as Topic; D013997:Time Factors; D016896:Treatment Outcome