Transcatheter Versus Surgical Closure Of Secundum Atrial Septal Defect:Focus On The Efficacy And Occurrence Of Atrial Arrhythmia. A Concurrent Matched Comparative Study

Objective:To compare the efficacy, safety and heart function between Amplatzer septal occluder and surgical closure of secundum atrial septal defect (ASD);To observe the prevalence of atrial arrhythmia before and after treatment;To investigate the risk factors of atrial arrhythmia after treatment.Methods:According to the same inclusion criteria,250patients from August2009to October2010in our hospital with secundum atrial septal defect were treated by transcatheter closure with Amplatzer septal occluder (108cases) or surgical closure (142cases). Successful rate,residual shunt rate,duration of the operation,the mean lengths of hospital stay,blood transfusion volume were compared between the two group, the heart size and atrial arrhythmia were also observed.Analyzed variables were entered into univariate (Student’s t tests) and multivariate (stepwise logistic regression) models to assess independent predictors for atrial arrhythmia.Results: 1. Comparison of transcatheter and surgical treatment of ASDCompared with the surgical treatment group, the procedural success rate in the transcatheter treatment group was significantly lower (96.3%vs100%). The residual shunt rate was higher (1.85%vs0%) than that in the surgical group,which completely disappeared after3months. The duration of the operation and the mean lengths of hospital stay in transcatheter treatment group were significantly shorter than that in surgical treatment group (57.24±18.69min vs.146.44±31.35min and5.2±1.8d vs.12.0±1.6d5.6±1.3%vs.32.5±5.4%)(P<0.01). Meanwhile,the complication rate in transcatheter treatment group were significantly lower than that in surgical treatment group (5.6±1.3%vs.32.5±5.4%)(P<0.01). In addition, no patient need blood transfusion in transcatheter treatment group.2. Comparison of changes of heart function between transcatheter and surgical treatmentThe RA and RVDd were all reduce to normal level after treatment in both group (P<0.05).But they have no significant difference after1month,3months,6months and12months of treatment.The LA and LVDd have no significant difference before and after treatment(P>0.05) in both group.And there are no significant difference with the RA,RVDd,RA, RVDd between the transcatheter group and surgery group (P>0.05). PASP of all the patient decreased significantly (P<0.05) after treatment immediately, and after1month,3months of treatment,.But there are no significant differences between the two groups (P>0.05).3. The incidence of atrial arrhythmia in transcatheter group and surgical groupThe incidence of arrhythmia was7.41%for transcatheter group before treatment,23.15%before discharge and1.85%3m after treatment.The incidence of arrhythmia was7.04%for surgery group before treatment,30.99%before discharge and1.85%3m after treatment.The incidence of arrhythmia of these two groups have no significant differences before treatment and before discharge (P>0.05). However,3M after treatment,the incidence of arrhythmia in the intervention group become significantly lower than that in the surgery group (P<0.05).4. Investigation the risk factors of atrial arrhythmia after treatmentAge, history of hypertension and arrhythmia enlargement of LA,the type of ASD,the ratio of C/T,operation methods have significantly statistical differences between the two groups after treatment before discharge(P>0.05).The incidence of arrhythmia was significantly higher in the goup of age older than40, superior vena cava type ASD, C/T>0.6,surgical group than those Less than40years old, ASD of other type,C/T<0.6,transcatheter treatment after3months(P<0.05).Meanwhile, risk factors were identified by multifactor noconditional logistic regression and it showed that age older than40years, operation methods and having arrhythmia histories were independent risk factors of postoperative atrial arrhythmia.Conclusion:Transcatheter and surgical treatment can improve the right heart geometric structure and heart functions immediately. However, transcatheter treatment have several advantages including less invasive, simpler operation, shorter duration of the operation, no need of CPB and transfusion, which is a promising non-invasive treatment strategy for ASD. The incidence of arrhythmia after3months for transcatheter treatment was lower than that for surgery group,Age older than40years, operation methods and having arrhythmia histories are risk factors for postoperative atrial arrhythmia.