Transthoracic occlusion for secundum atrial septal defects unsuitable for transcatheter occlusion approach

Transcatheter occlusion of secundum atrial septal defects is a safe and effective alternative to traditional surgical closure; however, it is associated with serious occasional complications and inapplicable to more than 20% of atrial septal defects. In 2000, transthoracic occlusion was pioneered at Xijing Hospital as a novel method of atrial septal defect closure. The purpose of this study is to report the early and mid-term results of the transthoracic occlusion procedure and to evaluate its safety and efficacy.

From April 2000 to April 2006, 268 patients with atrial septal defects were classified into 2 groups: group A (unsuitable for transcatheter occlusion, n = 126) and group B (n = 142). The transthoracic occlusion method used transesophageal echocardiographic-guided atrial septal defects occluder deployment via a right minithoracotomy without cardiopulmonary bypass or fluoroscopy.

Device implantation was successful in 265 patients (98.9%), including 9 elliptical devices in group A. The average size of circular occluders in group A was 38.2 ± 4.2 mm, which was larger than in group B (24.0 ± 4.5 mm) (P < .001). The average procedure time was 37.2 ± 9.2 minutes, the average intracardiac manipulation time was 5.8 ± 3.0 minutes, and the average inpatient stay was 3.2 ± 0.8 days. Twenty-five complications (9.3%) occurred in patients during the follow-up period. No large residual shunting, device embolization, or other severe complications resulted from transthoracic occlusion.

Transthoracic occlusion is a new safe and effective method for atrial septal defect treatment, even for patients with partial atrial septal defects unsuitable for transcatheter occlusion. This hybrid method broadens the indications of atrial septal defect treatment with device occlusion.