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J Thorac Cardiovasc Surg 1999;118:674-678
© 1999 Mosby, Inc.
SURGERY FOR CONGENITAL HEART DISEASE |
From the Klinik für Angeborene Herzfehlera und Klinik für Herz-, Thorax- und Gefäßchirurgie,b Deutsches Herzzentrum, Berlin, Germany.
Address for reprints: Felix Berger, MD, Deutsches Herzzentrum, Augustenburger Platz 1, 13353 Berlin, Germany (E-mail: fberger{at}dhzb.de).
Objectives: Results and complications of surgical versus transcatheter treatment of atrial septal defect in the current era are compared.
Methods: All consecutive patients with a secundum atrial septal defect and a pulmonary/systemic flow ratio of 1.5:1 or more who presented between May 1997 and June 1998 were enrolled in this study. All patients except those who initially had defects not feasible for interventional occlusion were catheterized to allow interventional closure of the defects. All patients in whom interventional closure could not be performed underwent surgical closure.
Results: Sixty-one patients underwent surgery at a median age of 20 years (0.5-74 years) and 61 had the defect closed with an Amplatzer device (AGA Medical Corporation, Golden Valley, Minn) at a median age of 12 years (0.8-77.7 years) (P > .2). Hospital stay in surgically treated patients was 8 days (6-19 days) versus 3 days (3-14 days) in interventionally treated patients (P < .001). Atrial septal defect and shunt sizes were larger in the surgical group ( P < .001). Closure rates in the 2 groups were identical (98%). One patient (68 years) in the surgical group had a perforated duodenal ulcer that necessitated an operation 8 days after closure of the atrial septal defect, and 1 (26 years) had an infected lateral thoracotomy wound necessitating plastic surgery. Embolization of the Amplatzer device to the left ventricle was observed in 1 patient (29 years). The device could be retrieved from the heart, but vascular surgery was required to extract it from the femoral artery.
Conclusions: As complete closure rates and complications are identical, but duration of hospital stay is shorter with less morbidity, we prefer implantation of an Amplatzer septal occluder to surgery wherever possible.
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