Vnitr Lek 2005, 51(10):1079-1086

Comparison of catheterisation and surgical treatment of ostium secundum type atrial septal defect in adult patients

P. Růžička^1,*, P. Malík¹, J. Černý¹, D. Kučera², M. Homza², P. Kala³, T. Brychta³

¹ Centrum kardiovaskulární a transplantační chirurgie, Brno, ředitel prof. MUDr. Jan Černý, CSc.

² Centrum vaskulárních intervencí Vítkovické nemocnice bl. Marie Antoníny, Ostrava-Vítkovice, přednosta prim MUDr. Miroslav Homza

³ Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC

The authors compared rertrospectively feasibility, efficacy, safety and mid-term results of transcatheter and surgical treatment of isolated ostium secundum atrial septal defect in adult patients. Transcatheter closure was performed in 32 patients and surgical closure in 39 patients. Both methods were well matched in feasibility (97 % vs 100 %; NS) and in the incidence of major complications (0.0 % vs 2.6 %; NS). There were fewer minor complications (9.4 % vs 59.0 %; p < 0.001) and shorter hospital stay (3.3 ± 1.3 days vs 12.6 ± 4.5 days; p < 0.001) but higher costs (206 ± 22 vs 129 ± 55 thousand Czech Crowns; p < 0.001) in the device group. No patient had a hemodynamically significant residual shunt on discharge. Trivial residual shunt was more frequent in the device group (25.0 % vs 5.1 %; p < 0.05), however, the difference was not significant after 12 months of follow-up (6.3 % vs 5.1 %; NS). There was a significant improvement in functional NYHA class after 12 months by comparison with the condition before intervention (transcatheter closure before/after: 1.9 ± 0.6 vs 1.2 ± 0.3; p < 0.001, surgical closure before/after: 2.0 ± 0.7 vs 1.3 ± 0.5; p < 0.001) and the size of right ventricle also diminished significantly (transcatheter closure before/after: 40.0 ± 4.8 mm vs 30.0 ± 2.1 mm; p < 0.001), surgical closure before/after: 38.2 ± 5.3 mm vs 31.3 ± 4.9 mm; p < 0.001). During one-year follow-up, no major complication or mortality occured and no reintervention or re-do surgery was undertaken. Ostium secundum atrial septal defect can be closed safely both by surgical and transcatheter method. The surgical treatment has stood the test of time and can be used in all types of atrial defects. However, it has higher incidence of minor complications and longer periods of hospitalisation. Whilst being less invasive, the transcatheter method is more expensive and suitable only for patients with appropriate defect morphology. Both types of defect closure lead to improved function and reduction of right ventricle in mid-term follow-up.

Keywords: atrial septal defect; transcatheter closure; Amplatzer; surgical closure

Received: December 15, 2004; Accepted: February 14, 2005; Published: October 1, 2005  Show citation