Transcatheter versus surgical closure of secundum atrial septal defect in adults: impact of age at intervention. A concurrent matched comparative study

• Published in: Congenital heart disease Vol. 2; no. 3; p. 148
• Main Authors: Rosas, Martin, Zabal, Carlos, Garcia-Montes, Jose, Buendia, Alfonso, Webb, Gary, Attie, Fause
• Format: Journal Article
• Language: English
• Published: United States 01-05-2007
• Subjects: Adult; Age Distribution; Age Factors; Cardiac Catheterization - adverse effects; Cardiac Surgical Procedures - adverse effects; Embolism - epidemiology; Embolism - etiology; Female; Heart Septal Defects, Atrial - therapy; Humans; Length of Stay; Male; Prostheses and Implants - adverse effects; Stroke - epidemiology; Stroke - etiology; Treatment Outcome
• ISSN: 1747-0803
• DOI: 10.1111/j.1747-0803.2007.00091.x

To compare the short- and mid-term outcomes of surgical (SUR) vs. transcatheter closure of secundum atrial septal defect (ASD) using Amplatzer septal occluder (ASO) in adults with a very similar spectrum of the disease; and to identify predictors for the primary end point.
Single-center, concurrent comparative study. Surgically treated patients were randomly matched (2:1) by age, sex, date of procedure, ASD size, and hemodynamic profile.
Tertiary referral center.
One hundred sixty-two concurrent patients with ASD submitted to ASO (n = 54) or SUR closure (n = 108) according with their preferences.
Primary end point was a composite index of major events including failure of the procedure, important bleeding, critical arrhythmias, serious infections, embolism, or any major cardiovascular intervention-related complication. Predictors of these major events were investigated.
Atrial septal defects were successfully closed in all patients, and there was no mortality. The primary event rate was 13.2% in ASO vs. 25.0% in SUR (P = .001). Multivariate analysis showed that higher rate of events was significantly associated with age >40 years; systemic/pulmonary output ratio <2.1; and systolic pulmonary arterial pressure >50 mm Hg; while in the ASO group the event rate was only associated with the ASD size (>15 cm(2)/m(2); relative risk = 1.75, 95% confidence interval 1.01-8.8). There were no differences in the event-free survival curves in adults with ages <40 years.
The efficacy for closure ASD was similar in both groups. The higher morbidity observed in SUR group was observed only in the patients submitted to the procedure with age >40 years. The length of hospital stay was shorter in the ASO group. Surgical closure is a safe and effective treatment, especially in young adults. There is certainly nothing wrong with continuing to do surgery in countries where the resources are limited.