Transcatheter and intraoperative device closure and surgical repair for atrial septal defect

Area of Science:

• Cardiology
• Minimally Invasive Surgery
• Medical Device Technology

Background:

• Conventional surgical repair of atrial septal defects (ASD) involves cardiopulmonary bypass (CPB), leading to larger incisions and potential injury.
• Transcatheter and intraoperative device closures are emerging alternatives aiming to minimize invasiveness.
• No prior studies have directly compared the safety and efficiency of these three ASD treatment modalities.

Purpose of the Study:

• To compare the safety and efficiency of transcatheter device closure, intraoperative device closure, and conventional surgical repair for isolated atrial septal defects (ASD).

Main Methods:

• Retrospective analysis of 87 patients with isolated ASD undergoing transcatheter device closure (n=45), intraoperative device closure (n=22), or surgical repair (n=20) between January 2018 and April 2018.
• Comparison of closure rates, operative times, CPB duration, aortic cross-clamping time, length of stay (ICU and hospital), ventilation time, incision size, and major adverse events.

Main Results:

• Successful closure rates were comparable across all three groups.
• Device closure groups demonstrated significantly shorter aortic cross-clamping time, CPB duration, and operative time compared to surgical repair.
• Patients undergoing device closure experienced shorter ICU stays, reduced postoperative mechanical ventilation, and shorter overall hospital stays, with smaller incisions than surgical repair.
• No significant differences in major adverse events were observed among the transcatheter, intraoperative, and surgical groups.

Conclusions:

• Transcatheter device closure, intraoperative device closure, and surgical repair are all safe and effective treatments for ASD.
• The transcatheter approach is recommended as the primary option for isolated secundum ASD, followed by the intraoperative approach, with surgical repair as a last resort, considering their respective advantages and disadvantages.