Fulltext

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

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

In: European Journal of Cardio-Thoracic Surgery, 2010, vol. 37, no. 6, p. 1285-1290

Ajouter à la liste personnelle
    Titre
    • Surgery for complications of trans-catheter closure of atrial septal defects: a multi-institutional study from the European Congenital Heart Surgeons Association
    Auteur
    • Sarris, George E.. Mitera Children's and Hygeia Hospitals, Marousi, Athens, Greece
    • Kirvassilis, George. Mitera Children's and Hygeia Hospitals, Marousi, Athens, Greece
    • Zavaropoulos, Prodromos. Mitera Children's and Hygeia Hospitals, Marousi, Athens, Greece
    • Belli, Emre. Marie Lannelongue Hospital, Le Plessis-Robinson, France
    • Berggren, Hakan. Children's Heart Center, The Queen Silvia Children's Hospital Goteborg, Goteborg, Sweden
    • Carrel, Thierry. Clinic for Cardiovascular Surgery, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland
    • Comas, Juan V.. Pediatric Heart Institute, Hospital Universitario Madrid, Madrid, Spain
    • Corno, Antonio F.. Alder Hey Royal Children Hospital, Liverpool, United Kingdom
    • Daenen, Willem. KUL University, Leuven, Belgium
    • Di Carlo, Duccio. Dipartimento Medico Chirurgico di Cardiologia Pediatrica, Rome, Italy
    • Ebels, Tjark. University Medical Center, Groningen, The Netherlands
    • Fragata, Jose. Hospital de Santa Marta, Lisboa, Portugal
    • Hamilton, Leslie. Freeman Hospital, Newcastle, United Kingdom
    • Hraska, Viktor. German Pediatric Heart Center, Asklepios Clinic, Sankt Augustin, Germany
    • Jacobs, Jeffrey. The Congenital Heart Institute of Florida, USA
    • Lazarov, Stojan. National Heart Hospital, Sofia, Bulgaria
    • Mavroudis, Constantine. The Children's Memorial Hospital, Chicago, Illinois, USA
    • Metras, Dominique. Hospital de la Timone, Marseille, France
    • Rubay, Jean. Clinique Universitaires Saint-Luc, Brussels, Belgium
    • Schreiber, Christian. German Heart Center, Clinic at the Technical University, Munich, Germany
    • Stellin, Giovanni. University of Padova Medical School, Padova, Italy
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Journal of Cardio-Thoracic Surgery, 2010, vol. 37, no. 6, p. 1285-1290. Elsevier Science B.V.
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:302041
    Summary
    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 (5-34mm) and devices of various types and sizes (range 12-60mm) were involved, including 13 devices less than 20mm. 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