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Long-Term Outcomes After Surgical vs. Transcatheter Closure of Atrial Septal Defects in Adults
Study Questions:
What is the comparative effectiveness and long-term safety of transcatheter versus surgical closure of secundum atrial septal defect (ASD) in adults?
Methods:
A retrospective population-based cohort study was performed of all patients ages 18-75 undergoing ASD closure in a Canadian province between 1988 and 2005. Provincial administrative databases were used. Primary outcomes were 5-year re-intervention rates and all-cause mortality. Secondary outcomes were onset of congestive heart failure within 1 year of the procedure, stroke, transient ischemic attack, and markers of health service use.
Results:
A total of 718 ASD closures were performed during the study period, of which 383 were surgical and 335 were transcatheter. Surgical procedures predominated in the early era of the study period, whereas transcatheter procedures predominated in the latter portion of the study period. The 5-year re-intervention rate was higher in patients with transcatheter ASD closure (7.9% vs. 0.3% at 5 years, p = 0.0038), with the majority of re-interventions occurring in the first year following the procedure. Long-term mortality was similar between the two groups (5.3% for the transcatheter group and 6.3% for the surgical group at 5 years, p = 1.0). Secondary outcomes were similar in the two study groups.
Conclusions:
The authors concluded that device closure of ASD is associated with a higher re-intervention rate, but similar mortality rate, as compared with surgical closure.
Perspective:
This retrospective study investigated long-term outcomes of device closure versus surgical closure of ASD. Limitations of this study included the retrospective design, use of administrative databases, and differing patient populations over the course of the study period. Patients undergoing surgical closure in the later surgical period (when device closure was available) likely had larger ASDs, which were not amenable to device closure. Nevertheless, this study demonstrates that transcatheter closure of ASD is safe and effective, and should be considered as first-line therapy when the anatomy is suitable. There has been recent interest in aortic erosion by devices abutting the aortic root. No device erosions were reported in this study, although the study was not designed to identify this specific complication. Of the four deaths in the ASD group in the current study, one was procedure, one was related to malignancy, one was due to hypoglycemia, and the other was unknown.
Keywords: Stroke, Ischemic Attack, Transient, Heart Septal Defects, Atrial, Canada, Heart Failure, Foramen Ovale, Patent, Hypoglycemia
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