title: In-Hospital and 4-Year Clinical Outcomes Following Transcatheter Versus Surgical Closure for Secundum Atrial Septal Defect in Adults: A National Cohort Propensity Score Analysis.
abstract: Atrial septal defect (ASD) closure is major therapy for patients with secundum ASD. Although surgical closure (SC) and transcatheter closure (TC) are usually performed in such patients, data on the long-term outcomes comparing TC and SC in adults are limited. Data on the participants of this cohort study were retrieved from Taiwan's National Health Insurance Research Database from 2004 to 2011. Secundum ASD patients > 18 years of age who underwent TC or SC were initially enrolled, and those with associated comorbidities were excluded. After propensity score matching, the clinical outcomes between the TC and SC groups were analyzed. There were 595 patients recruited in the TC group and 308 patients in the SC group. The SC group had a higher incidence of systemic thromboembolism (P < 0.001), ischemic stroke (P = 0.002), and all-cause mortality (P = 0.013) when compared with those of the TC group at the index hospitalization, and similar phenomena could also be seen in a around 4-year follow-up period after the procedures (systemic thromboembolism (P < 0.001, HR = 11.48, 95% CI: 3.29-40.05), ischemic stroke (P = 0.005, HR = 9.28, 95% CI: 1.94-44.39), and all-cause mortality (P = 0.035, HR = 2.28, 95% CI: 1.06-4.89). In addition, atrial fibrillation (P = 0.005) and atrial flutter (P = 0.049) more frequently developed in the SC group than in the TC group at the index hospitalization. The adult secundum ASD patients had lower incidence rates of systemic thromboembolism, ischemic stroke, and all-cause mortality after TC than those after SC in the 4-year follow-up after procedures. Transcatheter ASD closure should therefore be given priority.
authors.affiliation: From the Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan, R.O.C. (THC, CTM); Department of Medical Education, Chang Gung Memorial Hospital, Keelung, Taiwan, R.O.C (YCH, CCC); Division of Cardiology, Chang-Gung Memorial Hospital, Linkou (DYC, MLT); and Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan, R.O.C. (TYY, YSL).
authors.forename: Tien-Hsing
authors.initials: TH
authors.lastname: Chen
authors.forename: Yuan-Chuan
authors.initials: YC
authors.lastname: Hsiao
authors.forename: Chia-Chi
authors.initials: CC
authors.lastname: Cheng
authors.forename: Chun-Tai
authors.initials: CT
authors.lastname: Mao
authors.forename: Dong-Yi
authors.initials: DY
authors.lastname: Chen
authors.forename: Ming-Lung
authors.initials: ML
authors.lastname: Tsai
authors.forename: Teng-Yao
authors.initials: TY
authors.lastname: Yang
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Lin
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology