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J Thorac Cardiovasc Surg 2007;134:735-737
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Discussion

Dr Carl L. Backer (Chicago, Ill). My only conflict of interest is that I am a surgeon. The first question is, are there any cardiologists in the audience?

I want to congratulate Dr Walther and colleagues for focusing our attention, and ideally that of the interventional cardiologists, on this relatively new indication for surgery in patients with congenital heart disease. That new indication is surgical ASD closure after attempted device placement in the cardiac catheterization laboratory.

Of concern, Dr Walther has reported a nearly 10% incidence of surgical intervention for patients having complications of device placement. Within that group of patients, the most concerning are those requiring emergency surgery or those who had neurologic events. Two patients required an emergency operation and 7 patients had serious neurologic issues. One of those patients, in fact, died of sepsis after surgical device removal and ASD closure. Dr Walther appropriately compares these results with a 0% mortality with negligible morbidity in a series of surgical ASD closures totaling nearly 1000 patients.

At Children’s Memorial Hospital in Chicago, our series of surgical ASD closures is now 237 patients since 1990 with no mortality. Since 1997, of 143 patients undergoing attempted device closure, there were a total of 11 patients who underwent an interventional catheterization procedure and then were referred for surgery. Two patients were referred because the defect was too large and there was no room for device placement. Seven patients had attempted closure in the catheterization laboratory with the device, but were referred for elective surgery because the device closure was not successful. Two patients had attempted device closure and required emergency operation when the device embolized to the mitral valve and to the left atrium. Our incidence of requirement for surgical intervention of 7.7% is very similar to yours.

I have 3 . . . [Full Text of this Article]

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Surgical atrial septal defect closure after interventional occluder placement: Incidence and outcome

Thomas Walther, Christian Binner, Ardawan Rastan, Ingo Dähnert, Nicolas Doll, Volkmar Falk, Friedrich W. Mohr, and Martin Kostelka
J. Thorac. Cardiovasc. Surg. 2007 134: 731-737. [Abstract] [Full Text] [PDF]