Comparison of catheterisation and surgical treatment of ostium secundum type atrial septal defect in adult patients

Česká verzia

Authors: P. Růžička ¹; P. Malík ¹; J. Černý ¹; D. Kučera ²; M. Homza ²; P. Kala ³; T. Brychta ³
Authors place of work: Centrum kardiovaskulární a transplantační chirurgie, Brno, ředitel prof. MUDr. Jan Černý, CSc. ¹; Centrum vaskulárních intervencí Vítkovické nemocnice bl. Marie Antoníny, Ostrava-Vítkovice, přednosta prim MUDr. Miroslav Homza ²; Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC ³
Published in the journal: Vnitř Lék 2005; 51(10): 1079-1086
Category: Original Contributions

Summary

The authors compared rertrospectively feasibility, efficacy, safety and mid-term results of transcatheter and surgical treatment of isolated ostium secundum atrial septal defect in adult patients. Transcatheter closure was performed in 32 patients and surgical closure in 39 patients. Both methods were well matched in feasibility (97 % vs 100 %; NS) and in the incidence of major complications (0.0 % vs 2.6 %; NS). There were fewer minor complications (9.4 % vs 59.0 %; p < 0.001) and shorter hospital stay (3.3 ± 1.3 days vs 12.6 ± 4.5 days; p < 0.001) but higher costs (206 ± 22 vs 129 ± 55 thousand Czech Crowns; p < 0.001) in the device group. No patient had a hemodynamically significant residual shunt on discharge. Trivial residual shunt was more frequent in the device group (25.0 % vs 5.1 %; p < 0.05), however, the difference was not significant after 12 months of follow-up (6.3 % vs 5.1 %; NS). There was a significant improvement in functional NYHA class after 12 months by comparison with the condition before intervention (transcatheter closure before/after: 1.9 ± 0.6 vs 1.2 ± 0.3; p < 0.001, surgical closure before/after: 2.0 ± 0.7 vs 1.3 ± 0.5; p < 0.001) and the size of right ventricle also diminished significantly (transcatheter closure before/after: 40.0 ± 4.8 mm vs 30.0 ± 2.1 mm; p < 0.001), surgical closure before/after: 38.2 ± 5.3 mm vs 31.3 ± 4.9 mm; p < 0.001). During one-year follow-up, no major complication or mortality occured and no reintervention or re-do surgery was undertaken. Ostium secundum atrial septal defect can be closed safely both by surgical and transcatheter method. The surgical treatment has stood the test of time and can be used in all types of atrial defects. However, it has higher incidence of minor complications and longer periods of hospitalisation. Whilst being less invasive, the transcatheter method is more expensive and suitable only for patients with appropriate defect morphology. Both types of defect closure lead to improved function and reduction of right ventricle in mid-term follow-up.

Key words:
atrial septal defect – transcatheter closure – Amplatzer – surgical closure

Zdroje

1. Berger VM, Dahert I, Ewert P et al. Treatment of atrial septal defects in symptomatic children aged less than 2 years of age using the Amplatzer septal occluder. Cardiol Young 2000; 10: 534-537.

2. Black MD, Freedom RM. Minimally invasive repair of atrial septal defects. Ann Thorac Surg 1998; 65: 765-767.

3. Cowley CG, Lloyd TF, Bove EL et al. Comparison of results of closure of secundum atrial septal defect by surgery versus Amplatzer septal occluder. Am J Cardiol 2001; 88: 589-591.

4. Du ZD, Hijazi ZM, Kleinman CS et al. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol 2002; 39: 1836-1844.

5. Durongpisitkul K, Soongswang J, Laohaprasitiporn D et al. Comparison of atrial septal defect closure using Amplatzer septal occluder with surgery. Pediatr Cardiol 2002; 23: 36-40.

6. Fischer G, Kramer HH, Stieh J et al. Transcatheter closure of secundum atrial septal defects with the new self-expanding Amplatzer septal occluder. Eur Heart J 1999; 20: 541-549.

7. 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.

8. Harper RW, Mottram PM, McGaw DJ. Closure of secundum atrial septal defects with the Amplatzer septal occluder device: Techniques and problems. Cardiovasc Intervent 2002; 57: 508-524.

9. Hughes ML, Maskell G, Goh TH et al. 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.

10. Chan KC, Goodman MJ, Walsh K et al. Transcatheter closure of atrial septal defect and interatrial communications with a new self-expanding nitinol double disc device (Amplatzer septal occluder): multicentre UK experience. Heart 1999; 82: 300-306.

11. 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.

12. Khan JH, McElhinney DB, Reddy VM et al. A 5-year experience with surgical repair of atrial septal defect employing limited exposure. Cardiol Young, 1999; 9: 572-576.

13. Masura J, Gavora P, Formanek A et al. Transcatheter closure of secundum atrial septal defects using the new self-centering Amplatzer septal occluder: Initial human experience. Cathet Cardiovasc Diagn 1997; 42: 388-393.

14. 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.

15. 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.

16. Omeish A, Hijazi ZM. Transcatheter closure of atrial septal defects in children & adults using the Amplatzer septal occluder. J Interv Cardiol 2001; 14: 37-44.

17. Popelová J Vrozené srdeční vady v dospělosti. Praha: Grada Publishing 2003.

18. Tax P, Reich O, Marek J et al. Uzávěr defektu síňového septa Amplatzovou katetrizační technikou. Čs Pediat 2003; 8: 484-491.

19. Thomson JDR, Aburawi EH, Watterson KG et al. Surgical and transcatheter (Amplatzer) closure of atrial septal defects: a prospective comparison of results and cost. Heart 2002; 87: 466-469.

20. Veselka J, Mates M, Honěk T et al. Dospělí pacienti po operaci defektu septa síní typu ostium primum v dětském věku: echokardiografická studie. Vnitř Lék 2000; 46: 96-101.

21. Waight DJ, Koenig PR, Cao Q et al. Transcatheter closure of secundum atrial septal defects using the Amplatzer Septal Occluder: clinical experience and technical considerations. Curr Intervent Cardiol Rep 2000; 2: 70-77.