Risk factors for adverse events within one year after atrial septal closure in children: a retrospective follow-up study

Abstract

Introduction:Secundum atrial septal defect is one of the most common congenital heart defects. Previous paediatric studies have mainly addressed echocardiographic and few clinical factors among children associated with adverse events. The aim of this study was to identify neonatal and other clinical risk factors associated with adverse events up to one year after closure of atrial septal defect.Methods:This retrospective case–control study includes children born in Sweden between 2000 and 2014 that were treated surgically or percutaneously for an atrial septal defect. Conditional logistic regression was used to evaluate the association between major and minor adverse events and potential risk factors, adjusting for confounding factors including prematurity, neonatal sepsis, neonatal general ventilatory support, symptomatic atrial septal defects, and pulmonary hypertension.Results:Overall, 396 children with 400 atrial septal defect closures were included. The median body weight at closure was 14.5 (3.5–110) kg, and the median age was 3.0 (0.1–17.8) years. Overall, 110 minor adverse events and 68 major events were recorded in 87 and 49 children, respectively. Only symptomatic atrial septal defects were associated with both minor (odds ratio (OR) = 2.18, confidence interval (CI) 95% 1.05–8.06) and major (OR = 2.80 CI 95% 1.23–6.37) adverse events.Conclusion:There was no association between the investigated neonatal comorbidities and major or minor events after atrial septal defect closure. Patients with symptomatic atrial septal defects had a two to four times increased risk of having a major event, suggesting careful management and follow-up of these children prior to and after closure.

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“…The incidence of postoperative complications in symptomatic patients in our study was low [19] and comparable with reports in older asymptomatic patients [18,21,22]. Tanghoj et al studied risk factors for adverse events following transcatheter and surgical ASD closure in children born preterm and concluded that prematurity was not a risk factor for post-procedural complications despite earlier procedural age, larger ASD size, and higher comorbidity than term infants [23,24].…”

Epidemiology, prenatal diagnosis, and neonatal outcomes of congenital heart defects in eastern China: a hospital-based multicenter study

“…Second, we could not compare ASD for different criteria and we had no precise data about the diameter of ASD. Children with symptomatic ASD have higher morbidity than those with no symptoms, so future studies should provide further analysis by risk of ASD [36].…”

Epidemiology, Prenatal Diagnosis, and Neonatal Outcomes of Congenital Heart Defects in Eastern China: A Hospital-Based Multicenter Study

“…Therefore, the observed rates of ASD and CHD in the study might be overestimated than most previous studies [15,16,28]. A retrospective case-control study in Sweden including children under 18 years old, showed that only symptomatic ASD were associated adverse outcomes [38]. We should perform further analysis according to the risks of ASD in future.…”