| Objective To compare the indications.efficacy, complication and cost of transcatheter closure, minimal intraoperative closure and open heart surgical repair of secundum atrial septal defect in children.Methods310 patients (including 129 male and 181 female with age range from 1 to 12 years) with secundum atrial septal defect admitted to Shandong Provincial Hospital during 2004 Feb. and 2009 Dec.164 of 310 patients were treated by transcatheter closure (interventional group),29 of 310 by minimal intraoperative closure (mini-invasive group) and 117 of 310 by open heart surgical repair (open heart group). To compare their indications, success rate, operation time, complications, hospital stay and cost.Results①The success rate was 97.0% in interventional group,96.5% in mini-invasive group and 100% in open heart group, respectively. There's no significant difference in success rate among the three methods (p>0.05)②The diameters of atrial septal defect were 8-33mm (15.75±8.05) in interventional group,10～36mm (17.11±9.32) in mini-invasive group and 6-40mm (20.00±10.62) in open heart group, respectively. The diameters of ASD in open heart group were larger than that in the other two groups (p both<0.05).The diameters of occluder in interventional group were (17.9±8.2) mm and (19.4±8.9) mm in mini-invasive group。There were no significant difference between the two groups (p>0.05).③The complication rate was 1.8% in interventional group including 2 cases with atrial premature contraction and 1 case with first degree atrioventricular block. The complication rate was 10.3% in the mini-invasive group including 1 case with atrial fibrillation,1 case with atrial premature contraction and 1 case with pericardial effusion. The complication rate was 29.1%(34/117) in the open heart group including atrial fibrillation, incomplete right bundle branch block, complete right bundle branch block, respiratory infection, surgical wound infection, pleural effusion and pericardial effusion. The complication rate in the interventional group was much lower than that of the other two groups(p both<0.05).④51 patients in the open heart group accepted blood transfusion of mean volume (280.56±104.51)ml. No patients need blood transfusion in the interventional group and mini-invasive group.⑤The operation time was 30 to 90 min (49.8±15.0) in the intervention group, 50 to 105 min (61.4±20.8) in the mini-invasive group and 130 to 210 min (173.1±42.7) in the open heart group, respectively. The operation time of interventional group was much shorter than that of the other two groups (p both <0.01).⑥The costs were (24,800±2,500) RMB in the interventional group, (23,90013,200) RMB in the mini-invasive group and (17,20013,600) RMB in the open heart group, respectively. The cost in the interventional group was more expensive then that of the other two group (p both<0.05).⑦The mean lengths of hospital stay were (6.1310.92)days in the interventional group, (6.21±1.83)days in the mini-invasive group and (13.42±2.08)days in the open heart group, respectively. The open heart group had the longest time of hospital stay (p both<0.05).⑧The patients in the interventional group got out of bed after 24h post procedure, while the patients in the mini-invasive group and the open heart group required intensive care in the ICU for 24h post operation. The patients in the mini-invasive group got out of bed after 2 days post operation and the open heart group needed 5 days. The patients in the first two groups had significantly shorter recovery time than the third one.⑨There was no skin scar on in the interventional group. The patients had the skin scar of 2.5～3.5 cm on chest in the mini-invasive group and chest scare of 15-20 cm in the open heart group.⑩atients in the interventional group received local anesthesia or intravenous anesthesia without tracheal intubation. The patients in the mini-invasive group and the open heart group required general anaesthesia with tracheal intubation. And the open heart group also required cardiopulmonary bypass support.Conclusion①Transcatheter closure had an curative effect, low complications, rapid recovery and no skin scar, which is proper to be the first choice for the children with ASD.②Minimal intraoperative closure is similar with transcatheter closure in the indications, success rate and cost, etc. Although it has no X-ray radiation, but has relatively slow recovery and chest scar.③Open heart surgical repair had wide indications, high success rate and low cost. However, it had cardiopulmonary bypass support needed, blood transfusion needed, high complication rate, major trauma, long operation time, slow recovery and large chest scar, which is proper to be the secondary choice for the children with ASD. |
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