Clinical outcomes of a combined transcatheter and minimally invasive atrial septal defect repair program using a 'Heart Team' approach.

Abstract

BACKGROUND:

Contemporary transcatheter and minimally invasive approaches allow for improved cosmesis and eliminate sternotomy; however, access to a 'Heart Team' approach to minimally invasive atrial septal defect (ASD) repair remains limited in Canada.

METHODS:

Retrospective chart review of all minimally invasive atrial septal defect repairs performed between 2009 and 2017 at a quaternary cardiac care centre were included. We compared residual shunt, functional status, periprocedural complications, and hospital lengths-of-stay between patients undergoing transcatheter and minimally invasive endoscopic ASD repair.

RESULTS:

Between 2009 and 2017, 61 consecutive patients underwent ASD repair at a single centre: 28 patients underwent transcatheter closure (64.3% female; median age 57, interquartile range 43-70.5) and 33 patients underwent minimally invasive endoscopic repair (72.7% female; median age 37, interquartile range 24-50). Patient demographics were similar between the two groups with the exception of transcatheter patients having smaller defect size (1.65 cm versus 2.35 cm, p = 0.002). Procedural success was 93% (26/28) and 100% (33/33) for transcatheter and minimally invasive groups (p = 0.21), respectively. Periprocedural complications were similarly low between the two groups with the exception of longer hospital length-of-stay in the surgical patients (5 days vs 1 day, p < 0.0001). Over a follow-up period (transcatheter: 0.5-56.5 months, surgical: 0.25-89 months), there was no difference in residual shunt (14.3% versus 6.1%, p = 0.4) or NYHA I Functional Class (88.5% versus 96.9%, p = 0.21).

CONCLUSION:

Transcatheter and minimally invasive approaches to ASD repair are safe and feasible in selected patients using a 'Heart Team' approach and represent attractive alternatives to median sternotomy.

• Authors: Shahrukh N Bakar, Daniel J P Burns, Pantelis Diamantouros, Kumar Sridhar, Bob Kiaii, Michael W A Chu
• Journal: Journal of cardiothoracic surgery (J Cardiothorac Surg) Vol. 13 Issue 1 Pg. 11 (Jan 18 2018) ISSN: 1749-8090 [Electronic] England
• PMID: 29347955 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Cardiac Catheterization (adverse effects)
• Female
• Heart Septal Defects, Atrial (surgery)
• Humans
• Intraoperative Complications (etiology)
• Length of Stay
• Male
• Middle Aged
• Minimally Invasive Surgical Procedures (adverse effects)
• Patient Care Team
• Retrospective Studies
• Treatment Outcome
• Young Adult