Intraoperative device closure of large secundum atrial septal defects; a safe alternative to transcatheter closure

Objective: The aim of this study is to report our short and mid-term results of intraoperative device closure (IODC) in large secundum atrial septal defects (ASD), to evaluate its safety and to determine the impact of 'short' rim on the results. Methods: Sixty-eight patients with an ASD underwent IODC through a right minithoracotomy. Patients were divided into two groups: 37 patients in group I with one short rim (<= 5 mm) and 31 in group II with sufficient rims. A 2.5-3 cm parasternal incision was made in the right third or fourth intercostal space. A specially designed plastic sheath loaded with the device was inserted through the purse-string sutures placed on the right atrium. Under transesophageal echocardiographic guidance, it was advanced through the ASD into the left atrium and the device was deployed in place. Results: The procedure was successful in all. patients. The maximum diameter of the ASD ranged from 20 to 37 mm (mean 25 +/- 5 mm). There were 16 patients with the diameter of ASD more than 30 mm. The mean size of implanted devices was 29 4 mm. Redeployment with larger device occurred in seven patients in group I and three in group II (p > 0.05). Intracardiac manipulation time was 22 +/- 10 min in group I and 16 +/- 11 min in group II (p < 0.01). The total occlusion rate was 84% immediately after operation, 97% at 3 months, 98% at 1 year, and 100% at 2-, 3-, 4-year follow-up. There were no other late complications during the follow-up period of 3-63 months (mean 27 +/- 18 months). Conclusions: IODC is a safe and feasible technique in closing large ASDs. It has the advantages of cost savings, cosmetic results, and less trauma. Early and mid-term results are encouraging. In patients with ASD of a short rim, a larger device is recommended which does not influence the success rate of IODC. (c) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.