PERIOPERATIVE COMPLICATIONS FOLLOWING SURGICAL CLOSURE OF ATRIAL SEPTAL-DEFECT TYPE-II IN 232 PATIENTS - A BASE-LINE STUDY

This study intends to provide a detailed overview of the types and rat es of peri-operative complications after surgical correction of an iso lated ASD II. The transvenous approach to the occlusion of atrial sept al defects has yielded promising results during its first 5 years of c linical trials, but before it can be established as a routine measure, definite proof is needed to demonstrate that its rate of serious comp lications does at least not exceed that of the surgical closure. Betwe en 1985 and 1992, 232 consecutive patients underwent surgical closure of a secundum atrial septal defect. Among the patients 118 were childr en (<18 years; 79 girls and 39 boys) with a mean age of 8.9 +/- 5.2 ye ars (4 months-17 years) and 114 adults (74 women and 40 men) with a me an age of 28.5 +/- 10.8 years (18-69 years). Pre-operatively eight chi ldren (6.8%) and eight adults (7%) were treated for right heart failur e. Mean pulmonary artery pressure was 20.4 +/- 10.4 mmHg for the child ren and 19.3 +/- 7 mmHg for the adults. The average pulmonary artery t o systemic flow ratios were 2.9:1 and 3:1 for children and adults, res pectively. Thirty children (25.4%) and 15 adults (13.2%) underwent pat ch closure while direct suture was the method used for the remaining p atients. Average cardiopulmonary bypass time was 35.7 +/- 17.9 min for the children and 41.5 +/- 19.9 min for the adults. The length of the procedure (skin to skin) was a mean of 116 min in the young group, and 141 min in the adult group. One adult patient died during his hospita l stay as a consequence of sepsis (0.4% total mortality rate). Severe early complications (pericardial tamponade, renal failure, sepsis) occ urred in three children (2.5%) and ten adults (8.8%), moderately sever e complications (pneumonia, pleural effusion requiring thoracocenthesi s) in four children (3.4%) and seven adults (6.1%) and mild complicati ons (atelectasis, gastrointestinal, urinary tract infection, pleural e ffusion) in 86 children (72.9%) and 77 adults (67.5%). Only 25 childre n (21.2%) and 20 adults (17.5%) experienced an uneventful peri-operati ve period. The results show that an isolated secundum atrial septal de fect can be surgically closed with a minimal mortality but significant complications can occur. The majority of the early complications for the patients were of minor significance, and severe complications were observed more often in adults than in children.