title: Paradigm shift in the intervention for secundum atrial septal defect in an era of transcatheter closure: A national birth cohort study.
abstract: BACKGROUND
  Secundum atrial septal defect (ASDII) is a common congenital heart defect, but the intervention, either transcatheter or surgical, needs are unclear. This study was to examine the paradigm shift in its intervention in an era of transcatheter closure.
  
  
  RESULTS
  The study birth cohort 2000-2008 (2,070,145 live births) with complete postnatal medical data was derived from the national database (2000-2014) of Taiwan, a country with national health insurance and easily accessible high-standard medical care. We found 5,515 patients with simple ASDII (median follow-up 12.2 years, one-third diagnosed after age 6 years, incidence 2.66/1,000 live births). Excluding patients with coexisting ventricular septal defect, ASDII intervention was performed in 1,435 of 4,585 patients: transcatheter closure in 1,080 (23.6%) and surgery in 355 (7.8%). The interventional need is 0.69 per 1,000 live births: 0.52 per 1,000 for transcatheter closure and 0.17 per 1,000 for surgery. In the era of transcatheter closure (July 2004-December 2014), ASDII intervention increased to 3.56-fold, but the number of operations decreased to half. The freedom from intervention was lower, and the age at intervention was younger (freedom from intervention at age 6 years, 0.749 vs 0.805, P < .001). In patients born in the era of transcatheter closure, 19.5% (108/555) of the intervention was surgery. Atrioventricular block occurred in 1.12% of those patients after transcatheter closure and none after surgery (P = .149).
  
  
  CONCLUSIONS
  In the era of catheter intervention, the interventional criteria for ASDII are less strict and one-third of the patients may receive intervention, mostly transcatheter closure, at the pediatric ages.
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital, National Taiwan University Children's Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: wumh@ntu.edu.tw.
authors.forename: Mei-Hwan
authors.initials: MH
authors.lastname: Wu
authors.affiliation: Genomics Research Center, Academia Sinica, Taipei, Taiwan.
authors.forename: Hui-Chi
authors.initials: HC
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital, National Taiwan University Children's Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Jou-Kou
authors.initials: JK
authors.lastname: Wang
authors.affiliation: National Health Insurance Administration, Taipei, Taiwan.
authors.forename: Feng-Yu
authors.initials: FY
authors.lastname: Kao
authors.affiliation: National Health Insurance Administration, Taipei, Taiwan.
authors.forename: San-Kuei
authors.initials: SK
authors.lastname: Huang
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology