Transcatheter closure as an alternative and equivalent method to the surgical treatment of atrial septal defect in adults: comparison of early and late results
Elzbieta Suchon, Monika Pieculewicz, Wieslawa Tracz, Tadeusz Przewlocki, Jerzy Sadowski, Piotr Podolec
Med Sci Monit 2009; 15(12): CR612-617
The clinical efficacy of transcatheter atrial septal defect (ASD) closure with the Amplatzer Septal Occluder (ASO) can only be judged against the results of contemporaneous surgery. The present study compared early and late results of ASD closure using ASO versus open-heart surgery.
Material and Method: Forty-eight adult patients were found eligible for transcatheter closure in transesophageal echocardiography. The surgical group consisted of 52 patients with isolated ostium secundum ASD. All patients underwent standard ECG, 24-hour ECG recording, and transthoracic echocardiography pre-procedure at 1-month and at 1-year follow-up. Physical fitness was assessed by cardiopulmonary exercise testing (CPX) prior to ASD closure and at 1-year follow-up.
Results: ASD closure was successful in all surgical patients and in 94% of the ASO group (0% mortality). The total complication rate for surgical vs. device closure was not significantly different (19.2% vs. 26.7%; p=0.383), despite more serious complications in the surgical group. Hospital stay was significantly shorter in the ASO group (5.4+/-2.2 vs. 9.1+/-1.2 days; p<0.001). Although echocardiographic parameters did not differ significantly between the respective groups at 1-year follow-up, CPX revealed a higher decrease in the VE/VCO2 slope in the ASO group (-3.7+/-3.4 vs.-1.2+/-4.8; p=0.003).
Conclusions: As surgical and device closure appear similarly effective in adults with ASD, avoidance of thoracotomy and cardiopulmonary bypass, in conjunction with a shorter hospital stay, argues in favour of device closure in selected patients.
Keywords: Septal Occluder Device - adverse effects, Prospective Studies, Postoperative Hemorrhage - etiology, Middle Aged, Postoperative Complications - etiology, Length of Stay, Male, Humans, Heart Septal Defects, Atrial - ultrasonography, Exercise Test, Female, Echocardiography, Transesophageal, Cardiac Surgical Procedures - methods, Cardiac Catheterization - methods, Arrhythmias, Cardiac - etiology, Aged, Adult, Adolescent, Time Factors, Treatment Outcome, young adult