Minimally invasive or interventional repair of atrial septal defects in children: Experience in 171 cases and comparison with conventional strategies

OBJECTIVES The goal of this study was to evaluate percutaneous intervention al and minimally invasive surgical closure of secundum atrial septal defect (ASD) in children. BACKGROUND Concern has surrounded abandoning conventional midline sternotom y in favor of the less invasive approaches pursuing a better cosmetic resul t and a more rational resource utilization. METHODS A retrospective analysis was performed on the patients treated from June 1996 to December 1998. RESULTS One hundred seventy-one children (median age 5.8 years, median weig ht 22.1 kg) underwent 52 device implants, 72 minimally invasive surgical op erations and 50 conventional sternotomy operations. There were no deaths an d no residual left to right shunt in any of the groups. The overall complic ation rate causing delayed discharge nas 12.6% for minimally invasive surge ry, 12.0% for midline sternotomy and 3.8% for transcatheter device closure (p < 0.01). The mean hospital stay was 2.8 +/- 1.0 days, 6.5 +/- 2.1 days a nd 2.1 +/- 0.5 days (p < 0.01); the skin-to-skin time was 196 +/- 43 min, 1 63 +/- 46 min and 118 +/- 58 min, respectively (p < 0.001). Extracorporeal circulation time was 49.9 +/- 10.1 min in the minithoracotomy group versus 37.2 +/- 13.8 min in the sternotomy group ip < 0.01) but without difference s in aortic cross-clamping lime. Sternotomy was the most expensive procedur e (15,000 is an element of +/- 1,050 is an element of vs. 12,250 is an elem ent of +/- 472 is an element of for minithoracotomy and 13,000 is an elemen t of +/- 300 is an element of for percutaneous devices). CONCLUSIONS While equally effective compared with sternotomy, the cosmetic and financial appeal of the percutaneous and minimally invasive approaches must be weighed against their greater exposure to technical pitfalls. Adequ ate training is needed if a strategy of surgical or percutaneous minimally invasive closure of ASD in children is planned in place of conventional sur gery. (J Am Coil Cardiol 2001;37:1707-12) (C) 2001 by the American College of Cardiology.