Closure of atrial septal defects in children: surgery versus Amplatzer device implantation
Jacek Bialkowski1, Blandyna Karwot, Malgorzata Szkutnik
1Congenital Heart Disease & Pediatric Cardiology Department, Medical University of Silesia, Silesian Center for Heart Diseases, 41800 Zabrze, Poland. jabi_med@poczta.onet.pl
Insights
Percutaneous closure of atrial septal defects using the Amplatzer device resulted in fewer complications and less need for blood products compared to surgery. Surgical intervention remains valuable for complex cases.
Area of Science:
- Cardiology
- Pediatric Surgery
- Interventional Cardiology
Background:
- Secundum atrial septal defects (ASDs) are common congenital heart conditions.
- Both surgical and percutaneous closure methods are available for ASD treatment.
- Comparative data on complication rates between surgical and device closure are important for clinical decision-making.
Purpose of the Study:
- To prospectively compare closure and complication rates in children with secundum ASDs treated surgically versus with the Amplatzer septal occluder.
- To evaluate the safety and efficacy of transcatheter closure compared to surgical repair.
Main Methods:
- Prospective comparative study of 91 children with secundum ASDs.
- 44 children underwent surgical closure, and 47 were treated with percutaneous Amplatzer septal occluder.
- Complications were classified as mild, moderate, or severe; blood product administration was also recorded.
Main Results:
- Similar closure rates were observed: 95.5% in the surgical group and 97.5% in the device group.
- The Amplatzer device group experienced significantly fewer mild (2/47 vs 17/44), moderate (1/47 vs 11/44), and severe (0/47 vs 2/44) complications.
- Fewer blood products were administered in the device group (1/47 vs 18/44, P < 0.001).
Conclusions:
- Transcatheter closure of secundum ASDs with the Amplatzer device offers advantages of fewer complications, shorter hospitalization, and reduced need for blood products.
- Surgical closure remains a critical option, particularly for its ability to address ASDs of any size or location.
- The Amplatzer device presents a favorable alternative for suitable secundum ASD cases in pediatric patients.
Abstract:
We prospectively compared closure and complication rates in 91 children with secundum atrial septal defects: 44 (mean age, 8.1 +/- 4.7 years) were treated surgically and 47 (mean age, 10.1 +/- 4.9 years) were treated by percutaneous Amplatzer septal occluder Complications were classified as mild, moderate, or severe. The closure rate was similar in the 2 groups: 42/44 children (95.5%) in the surgical group versus 46/47 patients in the device group (97.5%). Mild complications were observed in 17/44 patients in the surgical group vs 2/47 in the device group; moderate, 11/44 in the surgical vs 1/47 in the device group; and severe, 2/44 in the surgical group vs none in the device group. Blood products were administered to 18 patients in the surgical group and to 1 patient in the device group (P < 0.001). Transcatheter closure of secundum atrial septal defects with the Amplatzer device has the advantage of fewer complications, shorter hospitalization, and reduced need of blood products. Nonetheless, the surgeon's ability to close any atrial septal defect regardless of its size or location remains an important advantage of surgery.
