Surgery for complications of trans-catheter closure of atrial septal defects: a multi-institutional study from the European Congenital Heart Surgeons Association

George E. Sarris, George Kirvassilis, Prodromos Zavaropoulos, Emre Belli, Hakan Berggren, Thierry Carrel, Juan V. Comas, Antonio F. Corno, Willem Daenen, Duccio Di Carlo, Tjark Ebels, Jose Fragata, Leslie Hamilton, Viktor Hraska, Jeffrey Jacobs, Stojan Lazarov, Constantine Mavroudis, Dominique Metras, Jean Rubay, Christian SchreiberGiovanni Stellin

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: This study aims to analyse the collective experience of participating European Congenital Heart Surgeons Association centres in the surgical management of complications resulting from trans-catheter closure of atrial septal defects (ASDs). Methods: The records of all (n = 56) patients, aged 3-70 years (median 18 years), who underwent surgery for complications of trans-catheter ASD closure in 19 participating institutions over a 10-year period (1997-2007) were retrospectively reviewed. Risk factors for surgical complications were sought. Surgical outcomes were compared with those reported for primary surgical ASD closure in the European Association of Cardio-thoracic Surgery Congenital Database. Results: A wide range of ASD sizes (5-34 mm) and devices of various types and sizes (range 12-60 mm) were involved, including 13 devices less than 20 mm. Complications leading to surgery included embolisation (n = 29), thrombosis/thrombo-embolism/cerebral ischaemia or stroke (n = 12), significant residual shunt (n = 12), aortic or atrial perforation or erosion (n = 9), haemopericardium with tamponade (n = 5), aortic or mitral valve injury (n = 2) and endocarditis (n = 1). Surgery (39 early emergent and 17 late operations) involved device removal, repair of damaged structures and ASD closure. Late operations were needed 12 days to 8 years (median 3 years) after device implantation. There were three hospital deaths (mortality 5.4%). During the same time period, mortality for all 4453 surgical ASD closures reported in the European Association of Cardio-Thoracic Surgery Congenital Database was 0.36% (p = 0.001). Conclusions: Trans-catheter device closure of ASDs, even in cases when small devices are used, can lead to significant complications requiring surgical intervention. Once a complication leading to surgery occurs, mortality is significantly greater than that of primary surgical ASD closure. Major complications can occur late after device placement. Therefore, lifelong follow-up of patients in whom ASDs have been closed by devices is mandatory.

Original languageEnglish (US)
Pages (from-to)1285-1290
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume37
Issue number6
DOIs
StatePublished - Jun 2010

Keywords

  • Atrial septal defect
  • Complication
  • Trans-catheter device

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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