title: Long-term outcomes after surgical versus transcatheter closure of atrial septal defects in adults.
abstract: OBJECTIVE
  The purpose of this study was to assess the comparative effectiveness and long-term safety of transcatheter versus surgical closure of secundum atrial septal defects (ASD) in adults.
  
  
  BACKGROUND
  Transcatheter ASD closure has largely replaced surgery in most industrialized countries, but long-term data comparing the 2 techniques are limited.
  
  
  METHODS
  We performed a retrospective population-based cohort study of all patients, ages 18 to 75 years, who had surgical or transcatheter ASD closure in Québec, Canada's second-largest province, using provincial administrative databases. Primary outcomes were long-term (5-year) reintervention and all-cause mortality. Secondary outcomes were short-term (1-year) onset of congestive heart failure, stroke, or transient ischemic attack, and markers of health service use.
  
  
  RESULTS
  Of the 718 ASD closures performed between 1988 and 2005, 383 were surgical and 335 were transcatheter. The long-term reintervention rate was higher in patients with transcatheter ASD closure (7.9% vs. 0.3% at 5 years, p = 0.0038), but the majority of these reinterventions occurred in the first year. Long-term mortality with the transcatheter technique was not inferior to surgical ASD closure (5.3% vs. 6.3% at 5 years, p = 1.00). Secondary outcomes were similar in the 2 groups.
  
  
  CONCLUSIONS
  Transcatheter ASD closure is associated with a higher long-term reintervention rate and long-term mortality that is not inferior to surgery. Overall, these data support the current practice of using transcatheter ASD closure in the majority of eligible patients and support the decision to intervene on ASD with significant shunts before symptoms become evident.
authors.affiliation: McGill Adult Unit for Congenital Heart Disease Excellence, McGill University Health Centre, Montréal, Québec, Canada.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Kotowycz
authors.forename: Judith
authors.initials: J
authors.lastname: Therrien
authors.forename: Raluca
authors.initials: R
authors.lastname: Ionescu-Ittu
authors.forename: Colum G
authors.initials: CG
authors.lastname: Owens
authors.forename: Louise
authors.initials: L
authors.lastname: Pilote
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martucci
authors.forename: Christo
authors.initials: C
authors.lastname: Tchervenkov
authors.forename: Ariane J
authors.initials: AJ
authors.lastname: Marelli
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D057186:Comparative Effectiveness Research; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006333:Heart Failure / Q000209:etiology; D006344:Heart Septal Defects, Atrial / Q000601:surgery / Q000628:therapy*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011792:Quebec; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome