Minimally invasive endoscopic surgery versus catheter-based device occlusion for atrial septal defects in adults: reconsideration of the standard of care
Standard
Minimally invasive endoscopic surgery versus catheter-based device occlusion for atrial septal defects in adults: reconsideration of the standard of care. / Schneeberger, Yvonne; Schaefer, Andreas; Conradi, Lenard; Brickwedel, Jens; Reichenspurner, Hermann; Kozlik-Feldmann, Rainer; Detter, Christian.
in: INTERACT CARDIOV TH, Jahrgang 24, Nr. 4, 01.04.2017, S. 603-608.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Minimally invasive endoscopic surgery versus catheter-based device occlusion for atrial septal defects in adults: reconsideration of the standard of care
AU - Schneeberger, Yvonne
AU - Schaefer, Andreas
AU - Conradi, Lenard
AU - Brickwedel, Jens
AU - Reichenspurner, Hermann
AU - Kozlik-Feldmann, Rainer
AU - Detter, Christian
N1 - © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Objectives: Percutaneous ostium secundum atrial septal defect (ASD II) closure has become the standard of care for treatment of congenital ASD II in adults. Nevertheless, patients are frequently ineligible for this technique due to challenging morphology. In such cases, closure via minimally invasive cardiac surgery (MICS) is an appropriate treatment option. The aim of this study is to compare outcomes of MICS and use of a percutaneous Amplatzer septal occluder (ASO) device for treatment of ASD II in adults.Methods: From July 2002 to June 2014, 95 patients underwent MICS for congenital ASD II closure. During the same period, 169 patients underwent ASO procedure. Outcomes in terms of remaining ASD II, new onset atrial fibrillation (AF), post-interventional stroke, myocardial infarction and the post procedural implementation of anticoagulation were compared.Results: Apart from age (38.3 ± 12.7 vs 49.6 ± 15.7 years, P < 0.0001) the groups did not differ in baseline characteristics. A significantly higher rate of residual ASD II was found in the ASO group at 3 months (0% vs 30.8%, P < 0.0001), 6 months (0% vs 15.9%, P < 0.0001) and 12 months follow-up (0% vs 7.1%, P = 0.005). A significantly higher rate of new-onset AF was seen in the ASO group (0% vs 9.5%, P = 0.0008).Conclusions: MICS for ASD II is a safe and reproducible procedure with 0% mortality in our cohort. More complete closure of ASD, decreased rates of new onset AF and decreased need for oral anticoagulation are the advantages of the MICS procedure. Compared with the current standard of care, the MICS approach is feasible regardless of ASD morphology.
AB - Objectives: Percutaneous ostium secundum atrial septal defect (ASD II) closure has become the standard of care for treatment of congenital ASD II in adults. Nevertheless, patients are frequently ineligible for this technique due to challenging morphology. In such cases, closure via minimally invasive cardiac surgery (MICS) is an appropriate treatment option. The aim of this study is to compare outcomes of MICS and use of a percutaneous Amplatzer septal occluder (ASO) device for treatment of ASD II in adults.Methods: From July 2002 to June 2014, 95 patients underwent MICS for congenital ASD II closure. During the same period, 169 patients underwent ASO procedure. Outcomes in terms of remaining ASD II, new onset atrial fibrillation (AF), post-interventional stroke, myocardial infarction and the post procedural implementation of anticoagulation were compared.Results: Apart from age (38.3 ± 12.7 vs 49.6 ± 15.7 years, P < 0.0001) the groups did not differ in baseline characteristics. A significantly higher rate of residual ASD II was found in the ASO group at 3 months (0% vs 30.8%, P < 0.0001), 6 months (0% vs 15.9%, P < 0.0001) and 12 months follow-up (0% vs 7.1%, P = 0.005). A significantly higher rate of new-onset AF was seen in the ASO group (0% vs 9.5%, P = 0.0008).Conclusions: MICS for ASD II is a safe and reproducible procedure with 0% mortality in our cohort. More complete closure of ASD, decreased rates of new onset AF and decreased need for oral anticoagulation are the advantages of the MICS procedure. Compared with the current standard of care, the MICS approach is feasible regardless of ASD morphology.
KW - Adult
KW - Aged
KW - Cardiac Catheterization/instrumentation
KW - Endoscopy
KW - Female
KW - Heart Septal Defects, Atrial/surgery
KW - Humans
KW - Male
KW - Middle Aged
KW - Retrospective Studies
KW - Septal Occluder Device
KW - Standard of Care
KW - Treatment Outcome
U2 - 10.1093/icvts/ivw366
DO - 10.1093/icvts/ivw366
M3 - SCORING: Journal article
C2 - 28040751
VL - 24
SP - 603
EP - 608
JO - INTERACT CARDIOV TH
JF - INTERACT CARDIOV TH
SN - 1569-9293
IS - 4
ER -