Comparative study of the transcatheter and transthoracic device closure treatments for atrial septal defect

Chen, Qiang; Cao, Hua; Chen, Zhaoyang; Zhang, Gui-Can; Xu, Fan; He, Jiajun

doi:10.1097/md.0000000000006316

Cited by 9 publications

(7 citation statements)

References 24 publications

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“…The intraoperative device closure technique used in group B has been described in previous studies [10][11][12][13][14][15]. In brief, the TEE probe was inserted after general anesthesia with endotracheal intubation was given to patients, and ASD closure was performed by only using TEE guidance.…”

Section: Methodsmentioning

confidence: 99%

“…In recent years, minimally invasive transesophageal echocardiography (TEE)-guided transthoracic occlusion has also been developed and applied in China. This technique can be used to directly puncture into the right atrium through a minimally invasive thoracic incision to avoid the possible damage of fluoroscopy and contrast agents to the body and the possibility of peripheral vascular injury [10][11][12][13][14][15]. For infants for whom percutaneous occlusion is unsuitable, transthoracic minimally invasive occlusion may be a good alternative.…”

Section: Introductionmentioning

confidence: 99%

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Transcatheter and intraoperative device closure of atrial septal defect in infants under three years of age

Han¹,

Zhang²,

Zhang³

2020

J Cardiothorac Surg

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Background: Transcatheter and intraoperative device closures have been widely used in the treatment of secundum atrial septal defect (ASD). However, for young infants with ASD, device closure remains controversial, and such treatment features limited data. We compared the clinical data and follow-up results of percutaneous and intraoperative device closure for ASD to evaluate the feasibility, safety, and efficacy of both treatments in infants under 3 years of age. Methods: From September 2010 to September 2018, 186 children under 3 years of age with significant secundum ASD were included in this study. A total of 88 and 98 patients were divided into groups A (transcatheter device closure) and B (intraoperative device closure), respectively. The clinical data and follow-up results of the two groups were analyzed retrospectively. Result: The mean age and weight of patients in group A were significantly higher than those in group B. The proportion of complex ASDs (multiples or rims deficiency) and the device/weight ratio in group B were significantly higher than those in group A. Successful closure was obtained in 86 (97.7%) and 96 (98.0%) infants in groups A and B, respectively, with two failed cases in each group (2.3% vs 2%). The rate of periprocedural complications reached 13.6 and 26.5% for groups A and B (P = 0.058), respectively. The durations of the procedure and postoperative hospital stay in group A were significantly shorter than those in group B (P < 0.05). Excellent follow-up results were observed in both groups. At present, no death nor major complications have occurred. Symptoms either resolved completely or improved significantly for all symptomatic infants. No residual shunts at the 6th month of follow-up evaluation were observed. Patients with failure to thrive gained weight appropriately for age, and the structure and hemodynamic parameters significantly improved during follow-up. Conclusion: Transcatheter and intraoperative device closure are feasible, effective, and safe methods for the treatment of ASDs in infants under 3 years of age. Considering improved cosmetic effect and the short duration of the procedure and postoperative hospital stay, transcatheter is preferred for patients with appropriate conditions. Intraoperative device closure can be performed as an alternative to percutaneous closure, particularly for infants with large, complex ASDs, young age, or low-body weight.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transcatheter and intraoperative device closure of atrial septal defect in infants under three years of age

Han¹,

Zhang²,

Zhang³

2020

J Cardiothorac Surg

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“…Inclusion criteria were: secundum ASD with adequate surrounding rims, hemodynamically significant left-to-right shunt, significant heart chamber enlargement, with/without the presence of clinical symptoms. The exclusion criteria included severe pulmonary hypertension, association with other congenital heart disease, heart function failure, and inability to obtain informed consent [11,12].…”

Section: Methodsmentioning

confidence: 99%

Comparison of Remifentanil-Based Fast-Track and Fentanyl-Based Routine Cardiac Anesthesia for Intraoperative Device Closure of Atrial Septal Defect (ASD) in Pediatric Patients

Huang

Lin

2019

Med Sci Monit

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Background The aim of this study was to evaluate the effectiveness and safety of remifentanil-based fast-track anesthesia for intraoperative device closure of atrial septal defects (ASDs). Material/Methods The clinical data of 152 pediatric patients who received intraoperative device closure of ASD in our hospital from January 2015 to December 2017 were retrospectively analyzed. Patients were divided into 2 groups: group F (remifentanil-based fast-track anesthesia group, n=72) and group C (fentanyl-based routine anesthesia group, n=80). The relevant data from 2 groups were collected and analyzed. Results No significant differences were found in the preoperative data or intraoperative hemodynamic index between these 2 groups. Group C was significantly inferior to group F regarding the duration of mechanical ventilation, length of intensive care unit (ICU) stay, length of hospital stay, and hospitalization expenses (P<0.05). In terms of postoperative complications, no death, third-degree atrioventricular block, occluder detachment, or residual leakage was reported in either group. The incidence of lung infections and bronchospasm was significantly higher in group C than in group F. There were no anesthetic-related complications. Conclusions The application of remifentanil-based fast-track anesthesia for intraoperative device closure of ASD is as effective and safe as fentanyl-based routine anesthesia. Moreover, remifentanil-based fast-track anesthesia has the advantages of shorter duration of mechanical ventilation, shorter length of hospital and ICU stay, fewer postoperative complications, and lower hospitalization expenses, and is therefore worthy of promotion in clinical practice.

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“…Moreover, with the real-time echocardiography monitor, the operative process can be better observed and guided. Once the device fails or procedure unsuccessful, it can be easily converted to conventional surgery with CPB (14). Of course, the new technology still has its limitations.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous transthoracic intervention for multiple cardiac defects in children

Sun¹,

Huang²,

Xie³

2021

Transl Pediatr

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Background: Transthoracic intervention for isolated congenital heart disease (CHD) has been well tested for its technological feasibility and is increasingly used in clinical practice. We aimed to present our experience in simultaneous transthoracic intervention for multiple cardiac lesions in a series of pediatric patients.Methods: Between March 2015 and December 2019, 20 patients with multiple CHD were referred to this study; mean age was 18.8±8.6 (range, 4-36) months. The transthoracic echocardiography (TTE) diagnosis was atrial septal defect (ASD) and perimembranous ventricular septal defect (pmVSD) in 7 patients, patent ductus arteriosus (PDA) and ASD in 6, pmVSD and PDA in 2, pmVSD and valvular pulmonary stenosis (PS) in 2, ASD and PS in 2, and doubly committed subarterial VSD (dcsVSD) and PS in 1 patient. These patients underwent simultaneous transthoracic interventions with transesophageal echocardiography guidance.The procedure sequence was PS→VSD→PDA→ASD. Electrocardiography and TTE were scheduled at discharge and follow-ups.Results: All patients were occluded successfully without any thoracotomy conversion. Operation time was 56-120 (mean, 75±13) minutes. A 1.5-2.0-cm median sternum incision was performed in 6 ASD&PDAs, 2 ASD&PSs, and 1 dcsVSD&PS. In 11 other patients, a 1.5-2.0-cm incision in the inferior sternum was made and the chest closed with a drain. There were no serious complications before discharge and at follow-up.Conclusions: Simultaneous transthoracic intervention for multiple cardiac defects in children is feasible with good short-term outcomes. For different lesions, the appropriate surgical incision and operational sequence can render the intervention minimally invasive and safer.

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Comparative study of the transcatheter and transthoracic device closure treatments for atrial septal defect

Cited by 9 publications

References 24 publications

Transcatheter and intraoperative device closure of atrial septal defect in infants under three years of age

Transcatheter and intraoperative device closure of atrial septal defect in infants under three years of age

Comparison of Remifentanil-Based Fast-Track and Fentanyl-Based Routine Cardiac Anesthesia for Intraoperative Device Closure of Atrial Septal Defect (ASD) in Pediatric Patients

Simultaneous transthoracic intervention for multiple cardiac defects in children

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