Abstract 21439: Long Term Safety of Children Undergoing Transcatheter versus Surgical Closure Of Atrial Septal Defect — A Population Based Study
Hypothesis: Currently, there are limited long-term safety data comparing transcatheter to surgical closure of pediatric patients with secundum atrial septal defects (ASD). In addition, there is growing interest in characterizing the neuro-developmental outcomes of the pediatric population that undergo cardiac surgery.
Methods: We used the Quebec congenital heart disease database to identify patients between 1 and 18 years of age that underwent transcatheter or surgical ASD closure between 1988–2005. Primary outcome was all cause mortality at long term follow up. Secondary morbidity outcomes were peri-procedural length of stay (LOS), need for re-intervention, health care resource utilization and new neuro-cognitive events post ASD closure. Neuro-cognitive events were defined as ICD-9 classified diagnoses of stroke, seizure disorder or neuro-developmental disorder as diagnosed by an appropriate specialist. Logistic regression adjusted for age was used for statistical analysis.
Results: From 1988–2005, 321/580 patients (55%) had surgical ASD closure. Comparing surgical to transcatheter closure, surgical patients were younger (median age 4.6 years [IQR 3.6–7.7] vs 5.7 [4.1–9.7], p< 0.0001) with no statistical difference between the two groups with respect to failure to thrive, congestive heart failure and pulmonary hypertension at time of intervention. There was no difference in mortality (1 (0.3%) vs. 0 (0%)) at 5 years. Despite an increased need for re-intervention (1 (0.3%) vs 9 (3.5%), p< 0.0023) and non-cardiologist outpatient visits (4 (IQR 2–8) vs 8 (IQR 5–13), p< 0.001), transcatheter closure of ASD was associated with a reduced median LOS (6 [IQR 5–7] vs 1 [1–1] days, p< 0.0001), fewer cardiologist outpatient visits (6 (IQR 3–12) vs 3 (IQR 2–4), p<0.001) and a 62% reduction in new neuro-cognitive events at 3 years (OR 0.38, 95% CI 0.15, 0.93).
Conclusion: In this large population based study of children, transcatheter ASD closure is a safe alternative to surgery with no difference in mortality at five years. In addition, transcatheter closure is associated with a statistically significant and important reduction in new neuro-cognitive events at a follow up of 3 years.
- © 2010 by American Heart Association, Inc.