Comparison of Clinical Outcomes After Transcatheter vs. Minimally Invasive Cardiac Surgery Closure for Atrial Septal Defect.
Percutaneous closure has replaced surgery for the majority of cases of secundum atrial septal defect (ASD). However, technological advances have made contemporary minimally invasive cardiac surgery (MICS) less invasive than conventional surgery. The aim of this study was to compare clinical outcomes of percutaneous closure of secundum ASD with those of contemporary MICS.



We conducted a single-center retrospective study of 354 patients with ASD treated either with the Amplatzer Septal Occluder (134 patients) or MICS (220 patients) between 2000 and 2013. Success rates and the incidence of complications were compared. The success rates were 98% for percutaneous closure and 100% for MICS. There were no deaths in either group. Major complications occurred in 2 patients (1.5%) who underwent percutaneous closure and in 8 patients (3.6%) treated with MICS (P=0.16). Minor complications occurred in 15 patients (11.2%) who underwent percutaneous closure and in 46 patients (20.9%) treated with MICS (P=0.02). On multivariate analysis, MICS (odds ratio [OR]: 2.91, 95% confidence interval [CI]: 1.46-5.81; P=0.002) and age >70 years (OR: 3.50, 95% CI: 1.40-8.75; P=0.008) were independent predictors of complications.



Percutaneous closure and MICS had high success rates without deaths. For ASD patients with a suitable anatomy, percutaneous closure can be considered as the first therapeutic option.
Department of Cardiology, Keio University School of Medicine.
Masaki
M
Kodaira
Akio
A
Kawamura
Kazuma
K
Okamoto
Hideaki
H
Kanazawa
Yugo
Y
Minakata
Mitsushige
M
Murata
Hideyuki
H
Shimizu
Keiichi
K
Fukuda
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D015999:Multivariate Analysis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome