CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 3, May/June 2014
114
AFRICA
Is there a role for surgery in the management of isolated
secundum atrial septal defect in adults?
Cengiz Bolcal, Gokhan Arslan, Murat Kadan, Suat Doganci, Cem Barcin, Atilla Iyisoy, Vedat Yildirim,
Mehmet Arslan
Abstract
Objectives:
The aim of this retrospective study was to
compare the short-term outcomes of surgical versus trans-
catheter closure of secundum atrial septal defect (ASD) in
adults.
Methods:
From January 2008 to October 2012, 229 patients
aged 18 years and older with significant isolated secundum
ASDs were admitted to our hospital. We focused only on
objective data obtained from their medical records. We
collected and compared a total of 163 patients with isolated
secundum ASD, who were treated with device occlusion
or surgical closure, and had no missing data. Postoperative
outcomes, rhythm disturbances, residual ASD, infection rates
and length of hospital stay were compared.
Results:
Complete follow-up data were available for 42
(46%) patients in the device group and for 121 (87%) in the
surgery group. Complete closure was observed in 41 of the
42 patients (97.6%) in the device group (
p
=
0.258) and in
all 121 in the surgery group (100 %) (
p
>
0.05). There were
no mortalities. The mean length of hospital stay in the device
group was 1.92
±
0.43 days and in the surgery group 7.14
±
0.14 days (
p
<
0.01).
Conclusions:
The transcatheter approach for closure of ASDs
is an effective and safe treatment option when performed for
certain indications. Broadening the spectrum of indications
may cause some adverse events. Surgical treatment remains
a good alternative for all patients with ASDs and can be
performed safely in order not to increase procedure-related
complications.
Keywords:
atrial septal defect, device occluder, cardiac surgery,
adult congenital heart disease
Submitted 26/2/14, accepted 14/3/14
Cardiovasc J Afr
2014;
25
: 114–117
DOI: 10.5830/CVJA-2014-015
Isolated atrial septal defect (ASD) is the most common form of
congenital heart abnormalities in adults and approximately 80%
are located in the region of the fossa ovalis (ostium secundum
ASD).
1
Indications for closure are in cases where the ratio of
pulmonary-to-systemic flow (Qp/Qs) is higher than 1.5, without
significant elevation of pulmonary vascular resistance.
Surgical closure of ASDs has been performed for over 60
years and techniques have steadily improved, using smaller
incisions and minimally invasive techniques. On the other hand,
in the last 20 years, various transcatheter ASD closure techniques
and devices have been developed, among which, percutaneous
treatment with a septal occluder device is the most popular.
2,3
Despite increasing use of occluder devices and the fact that
studies have been published internationally pointing out some
of the advantages and disadvantages compared with surgery
in adults, no formal comparison of efficacy, morbidity and
complications has been published.
2-4
We present a retrospective
comparison of short-term (three months) results for transcatheter
and surgical closure of 163 ostium secundum ASD patients in a
university hospital.
Methods
This was a retrospective analysis at a single centre, studying
two groups of adult patients with isolated secundum ASDs who
were treated by occlusion with a device, or with surgical closure.
Postoperative outcomes, rhythm disturbances, residual ASD,
infection rates and length of hospital stay of these two groups
were compared.
Between January 2008 and October 2012, 229 patients
admitted to our centre, aged 18 years and older with significant
isolated secundum ASDs, who had undergone surgical or
transcatheter closure of the ASD and who had follow-up data,
were assessed in this trial. Follow up was obtained from a chart
review and routine three-month post-repair check-up records. We
focused only on objective data obtained from the medical records
and we compared 163 patients with complete data in two groups
(device closure and surgery).
As routine practice in our clinic, secundum ASD assessment
is performed using transthoracic echocardiography (TTE)
and transoesophageal echocardiography (TEE). Defect size is
estimated by TTE and TEE, and also by balloon sizing. The
patients are assigned to device treatment or surgical closure
according to septum morphology, location of the defect, the
presence of rims around the defect, and the patient’s choice.
Department of Cardiovascular Surgery, Gulhane Military
Academy of Medicine, Ankara, Turkey
Cengiz Bolcal, MD,
Gokhan Arslan, MD
Murat Kadan, MD
Suat Doganci, MD
Mehmet Arslan, MD
Department of Cardiology, Gulhane Military Academy of
Medicine, Ankara, Turkey
Cem Barcin, MD
Atilla Iyisoy, MD
Department of Anesthesiology, Gulhane Military Academy
of Medicine, Ankara, Turkey
Vedat Yildirim, MD
