Transcatheter Versus Surgical Closure of Atrial Septal Defects in Children

Ooi, Yinn Khurn; Kelleman, Michael; Ehrlich, Alexandra; Glanville, Michelle; Porter, Arlene; Kim, Dennis; Kogon, Brian; Oster, Matthew E.

doi:10.1016/j.jcin.2015.09.028

Cited by 77 publications

(53 citation statements)

References 24 publications

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“…The approach to O-ASD has been consistent over the time period. As has been demonstrated in previous studies, the factors that result in a higher cost after operative procedures are primarily length of stay and adverse events (while transcatheter therapies are more expensive as a result of the cost of the device itself) (5,19,36). We expected that attention to these issues would have resulted in efforts to reduce post-operative length of stay.…”

Section: Discussionmentioning

confidence: 65%

“…Previous studies have demonstrated that TC-ASD has lower cost and shorter LOS than O-ASD(5,36). Over the study period, there were no significant changes in either following TC-ASD.…”

Section: Discussionmentioning

confidence: 97%

“…The risk of procedure-associated death in isolated TC-ASD in published series are 0–0.15%(30,34,35). The best estimates of risk-adjusted procedural mortality following O-ASD, as derived from the Society for Thoracic Surgeons Congenital Heart Surgeons Database, are between 3–9 per 1,000(5,36,37). Though there is risk standardization in these large series, care should be exercised in comparing outcomes between studies and the absolute risk of mortality with each procedure remains low.…”

Section: Discussionmentioning

confidence: 99%

“…Though there is risk standardization in these large series, care should be exercised in comparing outcomes between studies and the absolute risk of mortality with each procedure remains low. TC-ASD undeniably has other benefits over O-ASD, specifically shorter length of stay(5,36) and lower total cost relative to O-ASD(5,36), suggestive that in many cases TC-ASD represents better value than O-ASD.…”

Section: Discussionmentioning

confidence: 99%

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Increasing propensity to pursue operative closure of atrial septal defects following changes in the instructions for use of the Amplatzer Septal Occluder device: An observational study using data from the Pediatric Health Information Systems database

O’Byrne

Shinohara

Grant

et al. 2017

American Heart Journal

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Objectives Study trends in the treatment of atrial septal defects (ASD). Background Concern for device erosion following transcatheter treatment of ASD (TC-ASD) led in 2012 to a US FDA panel review and changes in the instructions for use (IFU) of the Amplatzer Septal Occluder (ASO) device. No studies have assessed the effect of these changes on real-world practice. Methods A retrospective observational study was performed using data from the Pediatric Health Information Systems Database of all patients with isolated ASD undergoing either TC-ASD or operative ASD closure (O-ASD) from 1/1/2007 to 9/30/2015, hypothesizing that the propensity to pursue O-ASD increased beginning in 2013. Results 6,392 cases from 39 centers underwent ASD closure (82% TC-ASD). Adjusting for patient factors, between 2007 and 2012, the probability of pursuing O-ASD decreased (OR: 0.95 per year, p=0.03). This trend reversed beginning in 2013, with the probability of O-ASD increasing annually (OR: 1.21, p=0.006). There was significant between-hospital variation in the choice between TC-ASD and O-ASD (median odds ratio: 2.79, p<0.0001). The age of patients undergoing ASD closure (regardless of method) decreased over the study period (p=0.04). Cost of O-ASD increased over the study period, while cost of TC-ASD and LOS for both O-ASD and TC-ASD was unchanged. Conclusion Though TC-ASD remains the predominant method of ASD closure, the propensity to pursue O-ASD has increased significantly following changes in IFU for ASO. Further research is necessary to determine what effect this has on outcomes and resource utilization.

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Section: Discussionmentioning

confidence: 65%

“…Previous studies have demonstrated that TC-ASD has lower cost and shorter LOS than O-ASD(5,36). Over the study period, there were no significant changes in either following TC-ASD.…”

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Increasing propensity to pursue operative closure of atrial septal defects following changes in the instructions for use of the Amplatzer Septal Occluder device: An observational study using data from the Pediatric Health Information Systems database

O’Byrne

Shinohara

Grant

et al. 2017

American Heart Journal

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show abstract

“…Minimal invasive therapies such as transcatheter aortic valve implantation (TAVI), devices for atrial septal defects (ASD), or clips to treat mitral regurgitation have become alternatives for surgical procedures. [1][2][3][4] As the expanding portfolio of interventional cardiology comes with new challenges, a need for imaging tools to support the cardiologist has arisen.…”

Section: Introductionmentioning

confidence: 99%

3D Hybrid Imaging for Structural and Congenital Heart Interventions in the Cath Lab

Broek

Krings

et al. 2018

Structural Heart

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Hybrid imaging (HI) during cardiovascular interventions enables the peri-procedural visualization of the organs and tissues by means of integrating different imaging modalities. HI can improve the procedural efficacy and safety. This review provides an overview of different systems, their possibilities and the current clinical use and benefits focused on structural and congenital heart diseases. We have performed a literature search and linked the software options to the clinical use in cardiology to gain insight into the clinical use of the systems. In this review, we focus on radiation and contrast exposure, complication rate and procedure time. We found that currently available studies are limited by small cohorts. Nevertheless, HI systems for valvular procedures result in a significant decrease of radiation and contrast exposure. The largest benefit hereof is observed when HI is used in combination with rotational angiography. Furthermore, automatically determined optimal implant angle for transcatheter aortic valve implantation decreases the complication rate significantly. Congenital heart disease interventions that require 2D/3D Transoesophageal echocardiography (TEE) such as septal defects show a significant decrease in radiation and contrast exposure and procedural time when using TEE-Mono-and bi-plane cine angiography and fluoroscopy (XRF) fusion software. MitraClip procedures using these HI systems, however, show only a trend in decrease of these effects. In conclusion, major interventional X-ray vendors offer HI software solutions which are safe and can aid the planning and image guidance of cardiovascular interventions. Even though current HI technologies have limitations, HI provides support in the increasingly complex cardiac interventional procedures to provide better patient care.

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Atrial Septal Defect, Partial Anomalous Pulmonary Venous Connection, and Scimitar Syndrome

Backer

Tannous

Mavroudis

2023

Pediatric Cardiac Surgery

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Transcatheter Versus Surgical Closure of Atrial Septal Defects in Children

Cited by 77 publications

References 24 publications

Increasing propensity to pursue operative closure of atrial septal defects following changes in the instructions for use of the Amplatzer Septal Occluder device: An observational study using data from the Pediatric Health Information Systems database

Increasing propensity to pursue operative closure of atrial septal defects following changes in the instructions for use of the Amplatzer Septal Occluder device: An observational study using data from the Pediatric Health Information Systems database

3D Hybrid Imaging for Structural and Congenital Heart Interventions in the Cath Lab

Atrial Septal Defect, Partial Anomalous Pulmonary Venous Connection, and Scimitar Syndrome

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