Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-23T08:55:23.876Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  22 December 2006

Gianfranco Butera ,
Mariella Lucente ,
Luca Rosti ,
Massimo Chessa ,
Angelo Micheletti ,
Alessandro Giamberti ,
Luciane Piazza ,
Raul Abella ,
Alessandro Frigiola  and
Mario Carminati
Gianfranco Butera
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, San Donato Milanese Hospital, Italy
Mariella Lucente
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, San Donato Milanese Hospital, Italy
Luca Rosti
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, San Donato Milanese Hospital, Italy
Massimo Chessa
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, San Donato Milanese Hospital, Italy
Angelo Micheletti
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, San Donato Milanese Hospital, Italy
Alessandro Giamberti
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, San Donato Milanese Hospital, Italy
Luciane Piazza
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, San Donato Milanese Hospital, Italy
Raul Abella
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, San Donato Milanese Hospital, Italy
Alessandro Frigiola
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, San Donato Milanese Hospital, Italy
Mario Carminati
Affiliation:
Department of Pediatric Cardiology and Cardiac Surgery, San Donato Milanese Hospital, Italy
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Interventional cardiologycongenital heart diseasesecundum atrial septal defect
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 1 , February 2007 , pp. 35 - 41
Copyright
2007 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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: 55–62.Google Scholar
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: 1156–1159.Google Scholar
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: 1381–1384.Google Scholar
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: 1645–1650.Google Scholar
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: 1431–1434.Google Scholar
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: 469–473.Google Scholar
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: 2035–2042.Google Scholar
Rome JJ, Keane JF, Perry SB, Spevak PJ, Lock JE. Double-umbrella closure of atrial septal defects: initial clinical application. Circulation 1990; 82: 751–758.Google Scholar
Sideris EB, Sideris SE, Thanoupoulos BD, Ehly RL, Fowlkes JR. Transvenous atrial septal defect occlusion by the buttoned device. Am J Cardiol 1990; 66: 1524–1526.Google Scholar
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: 1754–1764.Google Scholar
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: 468–473.Google Scholar
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: 1405–1413.Google Scholar
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: 319–324.Google Scholar
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: 1061–1065.Google Scholar
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: 711–716.Google Scholar
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: 241–245.Google Scholar
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: 607–629.Google Scholar
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, pp715–753.
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: 1100–1104.Google Scholar
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: 195–199.Google Scholar
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: 67–70.Google Scholar
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: 1707–1712.Google Scholar
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: 220–223.Google Scholar
Benson K, Hartz AJ. A comparison of observational studies and randomized, controlled trials. N Engl J Med 2000; 342: 1878–1886.Google Scholar
Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies and the hierarchy of research design. N Engl J Med 2000; 342: 1887–1892.Google Scholar
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: 496–502.Google Scholar
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: 190–197.Google Scholar