Transcatheter Vs. Surgical Closure of Atrial Septal Defects in Adults


Percutaneous transcatheter device closure of secundum atrial septal defects (ASD) has now largely replaced surgical closure in most centres. The aim of this study was to compare results of transcatheter and surgical ASD closure in adults in Latvia during the years 2002–2014 and to analyse long-term outcomes of transcatheter closure. We analysed data from 334 patients with secundum ASD who underwent ASD closure in Pauls Stradiņš Clinical University Hospital. Patients were included into device or surgical closure groups. In the device group, three follow-ups were made 1, 6, and 12 months after the procedure. No follow-up data were available for surgical arm patients beyond their hospitalisation period. The mean age of patients was 45.3 ± 19.9 years for the device group and 40.0 ± 16.9 years for the surgical group (p = 0.023). The mean secundum ASD size in the device and surgical groups was 14.2 ± 5.6 mm and 28.7 ± 10.0 mm, respectively (p < 0.001). No differences were observed regarding procedure success rates: 99.2% in the device group and 100% in the surgical group (p = 0.451). Periprocedural complications generally were more common in the surgical closure group. The study results show a successful introduction of the percutaneous ASD closure method in Latvia with good early and late outcomes and without significant differences in procedure success rate compared to surgical closure.

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  • Akagi, T. (2015). Current concept of transcatheter closure of atrial septal defect in adults. J. Cardiol., 65, 17–25.

  • Amin, Z., Hijazi, Z. M., Bass, J. L., Cheatham, J. P., Hellenbrand, W. E., Kleinman, C. S. (2004). 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. Off. J. Soc. Card. Angiogr. Interv., 63, 496–502.

  • Attie, F., Rosas, M., Granados, N., Zabal, C., Buendía, A., Calderón, J. (2001). Surgical treatment for secundum atrial septal defects in patients > 40 years old: A randomized clinical trial. J. Amer. Coll. Cardiol. 38, 2035–2042.

  • Baumgartner, H., Bonhoeffer, P., De Groot, N. M. S., De Haan, F., Deanfield, J. E., Galie, N., Gatzoulis, M. A., Gohlke-Baerwolf, C., Kaemmerer, H., Kilner, P., Meijboom, F., Mulder, B. J. M., Oechslin, E., Oliver, J. M., Serraf, A., Szatmari, A., Thaulow, E., Vouhe, P. R., Walma, E., Vahanian, A., Auricchio, A., Bax, J., Ceconi, C., Dean, V., Filippatos, G., Funck-Brentano, C., Hobbs, R., Kearney, P., McDonagh, T., Popescu, B. A., Reiner, Z., Sechtem, U., Sirnes, P.A., Tendera, M., Vardas, P., Widimsky, P., Swan, L., Andreotti, F., Beghetti, M., Borggrefe, M., Bozio, A., Brecker, S., Budts, W., Hess, J., Hirsch, R., Jondeau, G., Kokkonen, J., Kozelj, M., Kucukoglu, S., Laan, M., Lionis, C., Metreveli, I., Moons, P., Pieper, P. G., Pilossoff, V., Popelova, J., Price, S., Roos-Hesselink, J., Uva, M. S., Tornos, P., Trindade, P. T., Ukkonen, H., Walker, H., Webb, G. D., Westby, J. (2010). ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur. Heart J., 31, 2915–2957.

  • DiBardino, D. J., McElhinney, D. B., Kaza, A. K., Mayer, J. E. (2009). Analysis of the US Food and Drug Administration Manufacturer and User Facility Device Experience Database for Adverse Events involving Amplatzer Septal Occluder Devices and Comparison with the Society of Thoracic Surgery Congenital Cardiac Surgery Database. J. Thorac. Cardiovasc. Surg., 137, 1334–1341.

  • Du, Z. D., Hijazi, Z. M., Kleinman, C. S., Silverman, N. H., Larntz, K. (2002). Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults. Results of a multicenter nonrandomized trial. J. Amer. Coll. Cardiol., 39, 1836–1844.

  • Humenberger, M., Rosenhek, R., Gabriel, H., Rader, F., Heger, M., Klaar, U., Binder, T., Probst, P., Heinze, G., Maurer, G., Baumgartner, H. (2011). Benefit of atrial septal defect closure in adults: Impact of age. Eur. Heart J., 32, 553–560.

  • Kutty, S., Hazeem, A. A., Brown, K., Danford, C. J., Worley, S. E., Delaney, J. W., Danford, D. A., Latson, L. A. (2012). Long-term (5- to 20-year) outcomes after transcatheter or surgical treatment of hemodynamically significant isolated secundum atrial septal defect. Amer. J. Cardiol., 109, 1348–1352.

  • Levi, D. S., Moore, J. W. (2004). Embolization and retrieval of the Amplatzer septal occluder. Catheter. Cardiovasc. Interv. Off. J. Soc. Card. Angiogr. Interv., 61, 543–547.

  • Lindsey, J. B., Hillis, L. D. (2007). Clinical update: Atrial septal defect in adults. Lancet., 369, 1244–1246.

  • Marelli, A. J., Mackie, A. S., Ionescu-Ittu, R., Rahme, E., Pilote, L. (2006). Congenital heart disease in the general population: Changing prevalence and age distribution. Circulation., 115, 163–172.

  • Moore, J., Hegde, S., El-Said, H., Beekman, R., Benson, L., Bergersen, L., Holzer, R., Jenkins, K., Ringel, R., Rome, J., Vincent, R., Martin, G. (2013). ACC IMPACT Steering Committee, Transcatheter device closure of atrial septal defects: A safety review. JACC Cardiovasc. Interv., 6, 433–442.

  • Murphy, J. G., Gersh, B. J., McGoon, M. D., Mair, D. D., Porter, C. J., Ilstrup, D. M., McGoon, D. C., Puga, F. J., Kirklin, J. W., Danielson, G. K. (1990). Long-term outcome after surgical repair of isolated atrial septal defect. Follow-up at 27 to 32 years. New Engl. J. Med. 323, 1645–1650.

  • Ooi, Y. K., Kelleman, M., Ehrlich, A., Glanville, M., Porter, A., Kim, D., Kogon, B., Oster, M. E. (2016). Transcatheter versus surgical closure of atrial septal defects in children: A value comparison. JACC Cardiovasc. Interv., 9, 9–86.

  • Roberts, W. T., Parmar, J., Rajathurai, T. (2013). Very late erosion of Amplatzer septal occluder device presenting as pericardial pain and effusion 8 years after placement. Catheter. Cardiovasc. Interv. Off. J. Soc. Card. Angiogr. Interv., 82, E592–E594.

  • Roos-Hesselink, J. W., Meijboom, F. J., Spitaels, S. E. C., van Domburg, R., van Rijen, E. H. M., Utens, E. M. W. J., Bogers, A. J. J. C., Simoons, M. L. (2003). Excellent survival and low incidence of arrhythmias, stroke and heart failure long-term after surgical ASD closure at young age. Eur. Heart J., 24, 190–197.

  • Rosas, M., Zabal, C., Garcia-Montes, J., Buendia, A., Webb, G., Attie, F. (2007). Transcatheter versus surgical closure of secundum atrial septal defect in adults: Impact of age at intervention. A concurrent matched comparative study. Congenit. Heart Dis., 2, 148–155.

  • Van Der Linde, D., Konings, E. E. M., Slager, M. A., Witsenburg, M., Helbing, W. A., Takkenberg, J. J. M., Roos-Hesselink, J. W. (2011). Birth prevalence of congenital heart disease worldwide: A systematic review and meta-analysis. J. Amer. Coll. Cardiol., 58, 2241–2247.

  • Warnes, C. A., Williams, R. G., Bashore, T. M., Child, J. S., Connolly, H. M., Dearani, J. A., del Nido, P., Fasules, J. W., Graham Jr., T. P., Hijazi, Z. M., Hunt, S. A., King, M. E., Landzberg, M. J., Miner, P. D., Radford, M. J., Walsh, E. P., Webb, G. D. (2008). ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. J. Amer. Coll. Cardiol., 52, e1–e121.


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