Comparisons Of Transcatheter Device Closure, Minimally Invasive Transthoracic Device Closure And Median Sternotomy Repair For The Secundum Atrial Septal Defect

Background:Transcatheter device closure, minimally invasive transthoracic device closure and median sternotomy repair were three major operations for the secundum atrial septal defect.There are not data on comparisons of these three operations.Objective : To explain the advantages and disadvantages of above three different operations by comparing the efficiency,survival,complications,change of the ecocardiogram parameters and symptoms after intervention,hospital stay and costs.Methods:This was a historical cohort study.Patients who attempted transcatheter device closure,minimally invasive device closure or median sternotomy repair between December 2007 and December 2013 in Fujian Medical University Union Hospital,were included.Data about efficiency,survival,complications,change of the ecocardigram parameters and symptoms after intervention,hospital stay and costs of those patients,were collected from the electronic database,the archive records and telephone follow-up records.After individual matching(the same gender,the same age or age ±2 years,the same year of operation or year of operation ±2 years) and excluding patients who were other kinds of atrial septal defect or with other cardiac comorbidities needed to be corrected surgically.Patients who failed in primary operation and transferred to different operation,were excluded in analyses except efficiency analyses.Results : There were 334 available cases in the study(114 in cohort-1,118 in cohort-2,102 in cohort-3).The operation success rate was 95.6% in cohort-1,96.6%in cohort-2 and 100% in cohort-3 respectively. The mean follow-up was 38.2 months and the total mortality in hospital was 0.3%.The total mortality was 1.2%,most of which died of heart failure.Significantly more patients in cohort-2 and cohort-3suffered from complications,such as pneumonia,pericardial effusion,pleural effusion,pleural thickening.And patients in cohort-2 and cohort-3 had longer significantly hospital stay,length of intensive care,operation time,recovery time and length of mechanical vetilation than patients in cohort-1.There were no significant differences in change of echocardiogram parameters among three cohorts over time,except that more decreases of estimated pulmonary artery systolic pressure(EPASP) and right ventricular end diastolic diameter(RVEDD) were found in cohort-3.Three was no significant difference in change of symptoms between before and after intervention(P>0.05).While there were 5.5% patients in cohort- 1, 3.5%patients in cohort-2 and 5.9% patients in cohort-3 with residual shunts after operation before discharge,only 1.8% patients in cohort-1,0.9% patient in cohort-2 and 1.0%patient in cohort-3 had residual shunts 1 year after operation. Patients in cohort-1had the cheapest total costs,nursing costs,imaging and blood tests costs,other costs and the most expensive total operation costs,while patients in cohort-3 had the most expensive total costs,anesthesia costs, imaging and blood test costs and the cheapest operation costs.Conclusions :Three different operations for secundum atrial septal defect are all safe and effective.Patients who attempted transcatheter device closure had less complications,operation time,hospital stay after operation and costs than patients who attempted minimally invasive device closure and median sternotomy repair.Furthermore, adult patients who attempted transcatheter device closure were out of general anesthesia.