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Closure of atrial septal defects: is there still a place for surgery?

Thierry Bové (UGent) , Katrien Francois (UGent) , Katya De Groote (UGent) , Bert Suys, Daniël De Wolf (UGent) and Guido Van Nooten (UGent)
(2005) Acta Chirurgica Belgica. 105(5). p.497-503
Author
Organization
Abstract
Background : The purpose of this study is to assess the current management of atrial septal defect closure in an era of increasing feasibility of transcatheter device occlusion. Methods : Atrial septal defect (ASD) closure was performed surgically through complete sternotomy in 165 patients (group 1) and through partial inferior sternotomy in 53 patients (group 2). Transcatheter device occlusion was achieved in 82 patients with only ASD type 11 and patent foramen ovale (group 3). Results : Overall complications were minor and more frequent in group 1 : 26.7% versus 13.2% in group 2 and 14.6% in group 3 (p = 0.04). Compared to complete sternotomy, a partial sternotomy led to less chest tube loss (7.1 +/- 2.9 versus 11.6 +/- 14.5 ml/kg) (p < 0.05) and less postoperative pericardial effusion (11.3% versus 13.5%)(p = 0.55). ASD closure was effective in 99.4% in group 1, 100% in group 2 but only in 86.6% in group 3 (p < 0.05). Two major complications of device implantation required early surgery : 1 femoral arteriovenous fistula and I device embolization. Hospital stay was significantly shorter in group 3, as well as in group 2 compared to group 1 (8.3 +/- 4.2 versus 5.9 +/- 1.1 versus 2.1 +/- 7.3 days) (p < 0.05). Midterm results were excellent, with only I non-cardiac death and I re-operation for residual shunt in group 1, and I device removal for thrombosis in group 3. Conclusion : Transcatheter device occlusion has become an established treatment for ASD closure, achieving optimal results in older children and adults with anatomically suited ASD type II and PFO. However, a partial inferior sternotomy offers a valuable and complementary operative approach for all ASD variants, maintaining the predictable success of surgery, with the obvious advantages of minimal access in terms of morbidity, cosmetics and hospital stay.

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MLA
Bové, Thierry, Katrien Francois, Katya De Groote, et al. “Closure of Atrial Septal Defects: Is There Still a Place for Surgery?” Acta Chirurgica Belgica 105.5 (2005): 497–503. Print.
APA
Bové, T., Francois, K., De Groote, K., Suys, B., De Wolf, D., & Van Nooten, G. (2005). Closure of atrial septal defects: is there still a place for surgery? Acta Chirurgica Belgica, 105(5), 497–503.
Chicago author-date
Bové, Thierry, Katrien Francois, Katya De Groote, Bert Suys, Daniël De Wolf, and Guido Van Nooten. 2005. “Closure of Atrial Septal Defects: Is There Still a Place for Surgery?” Acta Chirurgica Belgica 105 (5): 497–503.
Chicago author-date (all authors)
Bové, Thierry, Katrien Francois, Katya De Groote, Bert Suys, Daniël De Wolf, and Guido Van Nooten. 2005. “Closure of Atrial Septal Defects: Is There Still a Place for Surgery?” Acta Chirurgica Belgica 105 (5): 497–503.
Vancouver
1.
Bové T, Francois K, De Groote K, Suys B, De Wolf D, Van Nooten G. Closure of atrial septal defects: is there still a place for surgery? Acta Chirurgica Belgica. 2005;105(5):497–503.
IEEE
[1]
T. Bové, K. Francois, K. De Groote, B. Suys, D. De Wolf, and G. Van Nooten, “Closure of atrial septal defects: is there still a place for surgery?,” Acta Chirurgica Belgica, vol. 105, no. 5, pp. 497–503, 2005.
@article{531367,
  abstract     = {Background : The purpose of this study is to assess the current management of atrial septal defect closure in an era of increasing feasibility of transcatheter device occlusion.
Methods : Atrial septal defect (ASD) closure was performed surgically through complete sternotomy in 165 patients (group 1) and through partial inferior sternotomy in 53 patients (group 2). Transcatheter device occlusion was achieved in 82 patients with only ASD type 11 and patent foramen ovale (group 3).

Results : Overall complications were minor and more frequent in group 1 : 26.7% versus 13.2% in group 2 and 14.6% in group 3 (p = 0.04). Compared to complete sternotomy, a partial sternotomy led to less chest tube loss (7.1 +/- 2.9 versus 11.6 +/- 14.5 ml/kg) (p < 0.05) and less postoperative pericardial effusion (11.3% versus 13.5%)(p = 0.55). ASD closure was effective in 99.4% in group 1, 100% in group 2 but only in 86.6% in group 3 (p < 0.05). Two major complications of device implantation required early surgery : 1 femoral arteriovenous fistula and I device embolization. Hospital stay was significantly shorter in group 3, as well as in group 2 compared to group 1 (8.3 +/- 4.2 versus 5.9 +/- 1.1 versus 2.1 +/- 7.3 days) (p < 0.05). Midterm results were excellent, with only I non-cardiac death and I re-operation for residual shunt in group 1, and I device removal for thrombosis in group 3.

Conclusion : Transcatheter device occlusion has become an established treatment for ASD closure, achieving optimal results in older children and adults with anatomically suited ASD type II and PFO. However, a partial inferior sternotomy offers a valuable and complementary operative approach for all ASD variants, maintaining the predictable success of surgery, with the obvious advantages of minimal access in terms of morbidity, cosmetics and hospital stay.},
  author       = {Bové, Thierry and Francois, Katrien and De Groote, Katya and Suys, Bert and De Wolf, Daniël and Van Nooten, Guido},
  issn         = {0001-5458},
  journal      = {Acta Chirurgica Belgica},
  language     = {eng},
  number       = {5},
  pages        = {497--503},
  title        = {Closure of atrial septal defects: is there still a place for surgery?},
  volume       = {105},
  year         = {2005},
}

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