Abstract:
Objective To compare the results of closure of secundum atrial septal defects (ASD) under transesophageal echocardiographic (TEE) guidance though right anterolateral minithoracotomy versus percutaneus approaches.
Methods Clinical data of 310 patients undergoing isolated closure of secundum ASD under TEE guidance between February 2008 and April 2020 at the Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University were retrospectively analyzed. There were 80 male and 230 female patients, aging from 2 to 76 years with a mean age of (40±14) years. Of these, 198 patients received percutaneous intervention (PI group) and 112 patients received right anterolateral minithoracotomy (RT group). Outcomes of the two groups were compared using t test and χ2 test.
Results There were no in-hospital deaths in both groups. The operation was successfully completely in 189 patients in the PI group and 108 patients in the RT group (95.5% vs 96.4%), and the occluder dislocation occurred in 3 patients in the PI group and 2 patients in the RT group (2.7% vs 1.0%), there was no significant difference between the two groups. Patients in the PI group was associated with a higher rate of endotracheal intubation removal in the operating room (76.8% vs 7.1%). Patients in the PI group had a shorter hospital stay (2.1±0.9 d vs3.8±1.6 d) and a lower rate of postoperative complications (0 vs 5.4%), these differences were statistically significant (P < 0.05).
Conclusions Closure of secundum ASD under TEE guidance via RT and PI are both safe and feasible without deaths. The PI has less trauma, shorter postoperative hospital stay and faster recovery. For ASD patients with a suitable anatomy, percutaneous closure can be considered as the first therapeutic option.
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