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A comparison between the early and mid-term results of surgical as opposed to percutaneous closure of defects in the oval fossa in children aged less than 6 years

  • Gianfranco Butera (a1), Mariella Lucente (a1), Luca Rosti (a1), Massimo Chessa (a1), Angelo Micheletti (a1), Alessandro Giamberti (a1), Luciane Piazza (a1), Raul Abella (a1), Alessandro Frigiola (a1) and Mario Carminati (a1)...
Abstract

Objectives: To compare surgical as opposed to percutaneous interventional closure of isolated atrial septal defects in the oval fossa in terms of hospital stay, efficacy, and complications, and to study the respective role of the two techniques in current practice. Methods: Between January 1998 and April 2004, 126 out of 1210 patients treated at our institution for closure of an isolated defect in the oval fossa were aged less than 6 years. The mean age of these 126 patients at procedure was 4.2 plus or minus 1 year. The ratio of females to males was 74 to 52. Results: Of the patients, 62% were treated successfully using a percutaneous approach. The groups treated surgically or percutaneously did not differ for age, gender, or indications for treatment. No deaths occurred. The rates of total and major complications were higher in the group undergoing surgical closure, at 34% versus 9%, p less than 0.0001, and 10.5% versus 1%, p equal to 0.01, respectively. Embolisation of the device requiring subsequent surgery occurred in 1% of patients. The stay in hospital was shorter in those closed percutaneously, at 3.2 plus or minus 0.9 days versus 6.8 plus or minus 2.8 days, p equal to 0.0001. During a mean follow-up of 3.4 plus or minus 1.9 years, no major complications occurred in either group, and symptoms improved significantly in both groups. Additional sequels occurred in 2 patients who had major complications subsequent to surgical closure. Conclusions: Even in young children, it is both feasible and safe to close defects in the oval fossa percutaneously. Compared to surgical closure, the transcatheter approach allows a shorter stay in hospital, and has a lower rate of complications. Early and mid-term follow-up has confirmed the safety and efficacy of both techniques.

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Corresponding author
Correspondence to: Dr Gianfranco Butera, Department of Pediatric Cardiology, San Donato Milanese Hospital, Via Morandi, 30, 20097 San Donato Milanese, Italy. Tel: +39 2 5277 4328; Fax: +39 2 5277 4459; E-mail: gianfra.but@lycos.com
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References

Dickinson DF, Arnold R, Wilkinson JL. Congenital heart disease among 160,480 liveborn children in Liverpool 1960 to 1969: implications of surgical treatment. Br Heart J 1981; 46: 5562.
Horvath KA, Burke RP, Collins JJ Jr, Cohn LH. Surgical treatment of atrial septal defect: early and long term results. J Am Coll Cardiol 1992; 20: 11561159.
Galal MO, Wobst A, Halees Z, et al. Peri-operative complications following surgical closure of atrial septal defect type II in 232 patients – a baseline study. Eur Heart J 1994; 15: 13811384.
Murphy JG, Gersh BJ, Mc Goon MD, et al. Long term outcome after surgical repair of isolated atrial septal defect: follow-up at 27 to 32 years. N Engl J Med 1990; 323: 16451650.
Meijboom F, Hess J, Szatmari A, et al. Long term follow-up (9 to 20 years) after surgical closure of atrial septal defect at a young age. Am J Cardiol 1993; 72: 14311434.
Konstantidines S, Geibel A, Olschewski M, et al. A comparison of surgical and medical therapy for atrial septal defect in adults. N Engl J Med 1995; 333: 469473.
Attie F, Rosas M, Granados N, Zabal C, Buendia A, Calderon J. Surgical treatment for secundum atrial septal defects in patients >40 years old. A randomized clinical trial. J Am Coll Cardiol 2001; 38: 20352042.
Rome JJ, Keane JF, Perry SB, Spevak PJ, Lock JE. Double-umbrella closure of atrial septal defects: initial clinical application. Circulation 1990; 82: 751758.
Sideris EB, Sideris SE, Thanoupoulos BD, Ehly RL, Fowlkes JR. Transvenous atrial septal defect occlusion by the buttoned device. Am J Cardiol 1990; 66: 15241526.
Das GS, Voss G, Jarvis G, Wyche K, Gunther R, Wilson RF. Experimental atrial septal closure with a new, transcatheter self centering device. Circulation 1993; 88: 17541764.
Berger F, Ewert P, Bjornstad PG, et al. Transcatheter closure as standard treatment for most interatrial defects: experience in 200 patients treated with Amplatzer septal occluder. Cardiol Young 1999; 9: 468473.
Sievert H, Babic UU, Hausdorf G, et al. Transcatheter closure of atrial septal defect and patent foramen ovale with the ASDOS device: a multi-institutional European trial. Am J Cardiol 1998; 82: 14051413.
Carminati M, Chessa M, Butera G, et al. Transcatheter closure of atrial septal defects with the STARFlex device: early results and follow-up. J Interv Cardiol 2001; 14: 319324.
Chessa M, Carminati M, Butera G, et al. Early and late complications associated with transcatheter occlusion of secundum atrial septal defect. J Am Coll Cardiol 2002; 39: 10611065.
Zhan EM, Wilson N, Cutright W, Latson LA. Development and testing of the Helex septal occluder, a new expanded pTFE atrial septal occlusion system. Circulation 2001; 104: 711716.
Butera G, De Rosa G, Chessa M, et al. Transcatheter closure of atrial septal defect in young children: results and follow-up. J Am Coll Cardiol 2003; 42: 241245.
Burgio GR. Il bambino con infezioni ricorrenti. In: Plebani A (ed.). Immunologia Pediatrica. McGraw Hill, Libri Italia, Milano, 1998, p17.
Hamil PV, Drizd TA, Johnson CL, Reed RB, Roche AF, Moore WM. Physical growth: National Center for Health Statistics percentiles. Am J Clin Nutr 1979; 32: 607629.
Kouchoukos NT, Blackstone EH, Doty DB, Hanley FL, Karp RB. Atrial septal defects. In: Kirklin JW, Barratt-Boyes BG (eds). Cardiac Surgery, 3rd edn. Elsevier Science (USA), 2003, pp715753.
Gundry SR, Shatteck OH, Razzouk AJ, del Rio MJ, Sardari FF, Bailey LL. Facile minimally invasive cardiac surgery via ministernotomy. Ann Thorac Surg 1998; 65: 11001104.
Siegel S, Castellan NJ. Nonparametric statistics for behavioural sciences. McGraw Hill, Italia, Milan, 1992.
Helgason H, Jonsdottir G. Spontaneous closure of atrial septal defects. Pediatr Cardiol 1999; 20: 195199.
Hughes ML, Maskell G, Goh TH, Wilkinson JL. Prospective comparison of costs and short term health outcomes of surgical versus device closure of atrial septal defect in children. Heart 2002; 88: 6770.
Formigari R, Di Donato RM, Mazzera E, et al. Minimally invasive or interventional repair of atrial septal defects in children: experience in 171 cases and comparison with conventional strategies. J Am Coll Cardiol 2001; 37: 17071712.
Bialkowski J, Karwot B, Szkutnik M, Banaszak P, Kusa J, Skalski J. Closure of atrial septal defects in children: surgery versus Amplatzer device implantation. Tex Heart Inst J 2004; 31: 220223.
Benson K, Hartz AJ. A comparison of observational studies and randomized, controlled trials. N Engl J Med 2000; 342: 18781886.
Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies and the hierarchy of research design. N Engl J Med 2000; 342: 18871892.
Amin Z, Hijazi ZM, Bass JL, Cheatham JP, Hellenbrand WE, Kleinman CS. Erosion of Amplatzer septal occluder device after closure of secundum atrial septal defects: review of registry of complications and recommendations to minimize future risk. Catheter Cardiovasc Interv 2004; 63: 496502.
Roos-Hesselink JW, Mejiboom FJ, Spitaels SE, et al. Excellent survival and low incidence of arrhythmias, stroke and heart failure long-term after surgical ASD closure at young age. A prospective follow-up study of 21–33 years. Eur Heart J 2003; 24: 190197.
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Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
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