Abstract 17487: Long-Term Outcomes After Surgical vs Transcatheter Closure of Atrial Septal Defects in Adults
Background: Transcatheter closure of secundum atrial septal defects (ASDs) has largely replaced surgery in most industrialized countries. Long-term data comparing the techniques is limited. Our objectives were to examine temporal trends in surgical vs. transcatheter ASD closure and to compare long-term re-intervention and mortality rates between the two techniques.
Methods: We performed a retrospective population-based cohort study of all adult patients who underwent ASD closure in the province of Québec between 1988 and 2005. Data were obtained from administrative databases that record all medical encounters within the province. Primary outcomes were re-intervention and all-cause mortality. Secondary outcomes were new onset atrial fibrillation (AF), congestive heart failure (CHF) and stroke, as well as markers of health service utilization, measured one year post intervention.
Results: Of the 718 patients in our study, 383 were closed surgically and 335 had transcatheter closure (median follow-up 10 years surgical, 3 years transcatheter). The long-term re-intervention rate was higher in patients with transcatheter closure (5.4% vs. 0.3% at 5 years, p < 0.001, HR 32.3, 95% CI 3.9-265.8) and persisted after adjusting for comorbidities. The majority of re-interventions in the transcatheter group occurred in the first year. Long-term mortality was lower in the transcatheter group (HR 0.278, 95% CI 0.095-0.810) and persisted after adjusting for comorbidities. In the year following ASD closure, there was no difference in the rate of AF, CHF or stroke between the two groups and there was no difference in the number of patients with outpatient physician visits, emergency department visits, or critical care hospitalizations.
Conclusion: Compared to surgical closure, transcatheter closure of secundum ASDs is associated with a higher re-intervention rate in the first year, lower long-term mortality, and similar rates of AF, CHF, and stroke in the first year. Overall, our data support the current practice of using transcatheter closure in the majority of patients. In those patients where only surgical closure is possible, careful patient selection is required because the technique seems to be associated with higher mortality.
- © 2010 by American Heart Association, Inc.