Transcatheter versus surgical closure of atrial septal defects: a systematic review and meta-analysis of clinical outcomes

Background: Atrial septal defects are a common form of CHD and dependent on the size and nature of atrial septal defects, closure may be warranted. The paper aims to compare outcomes of transcatheter versus surgical repair of atrial septal defects. Methods: A comprehensive electronic literature search was conducted. Primary studies were included if they compared both closure techniques. Primary outcomes included procedural success, mortality, and reintervention rate. Secondary outcomes included residual defect and mean hospital stay. Results: A total of 33 studies were included in meta-analysis. Mean total hospital stay was significantly shorter in the transcatheter cohort across both the adult (95% confidence interval, mean difference −4.05 (−4.78, −3.32) p < 0.00001) and paediatric populations (95% confidence interval, mean difference −4.78 (−5.97, −3.60) p < 0.00001). There were significantly fewer complications in the transcatheter group across both the adult (odds ratio 0.45, 95% confidence interval, [0.28, 0.72], p < 0.00001) and paediatric cohorts (odds ratio 0.26, 95% confidence interval, [0.14, 0.49], p < 0.00001). No significant difference in overall mortality was found between transcatheter versus surgical closure across the two groups, adult (odds ratio 0.76, 95% confidence interval, [0.40, 1.45], p = 0.41), paediatrics (odds ratio 0.62, 95% confidence interval, [0.21, 1.83], p = 0.39). Conclusion: Both transcatheter and surgical approaches are safe and effective techniques for atrial septal defect closure. Our study has demonstrated the benefits of transcatheter closure in terms of lower complication rates and mean hospital stay. However, surgery still has a place for more complex closure and, as we have demonstrated, shows no difference in mortality.

Agitated Saline Contrast Echocardiogram In Cardio-Pulmonary Evaluation

Agitated saline contrast echocardiogram (ASC) is a very useful technique to detect various intracardiac and extra cardiac shunts in daily cardiology practice . Conventional 2D and color echocardiogram may not be well effective in ruling out various intracardiac shunts especially with patients having poor echo window. The introduction of agitated saline with bubbles formed during the study can help delineate different right to left shunt physiology commonly like patent foramen ovale (PFO) which is often sought for in evaluation of cases with young stroke . Various other etiologies like atrial septal defects, atrial septal aneurysm, large right to left shunts with eisenmengerisation can also be evaluated with this simple bedside study.

Transcatheter Closure of Atrial Septal Defects with 40 mm Septal Occluder in Shahid Gangalal National Heart Centre, Nepal

Background and Aims: Transcatheter closure of Atrial septal defect (ASD) is one of important modality of treatment these days for ASD secundum. However, there is a paucity of data on transcatheter closure of ASDs with ³40 septal occluder. We aim to study the outcome of ASD device closure with ³40 mm Septal Occluder in Shahid Gangalal National Heart Centre, Nepal. Methods: It was a prospective single center study conducted at Shahid Gangalal National Heart Centre, Nepal.Among the 27 patient who underwent successful device closure with ³40 mm devices from January 2016 till December 2019, twenty-six patients could be prospectively followed up during May 2020 till December 2020. A Performa was designed to collect information about age, gender, ASD size, ASD device type and size. Right atrium(RA) and right ventricle(RV) dimension, level of tricuspid regurgitation (TR) and tricuspid regurgitation pressure gradient before the procedure and at the time of follow up were also recorded. Results: Amplatzer septal occluder (40mm) was used in 25 (96.1%) patients and Memopart device (42mm) was used in 1 (3.9%) patient. Before the procedure all patients had dilated RA and RV, Mild TR, moderate TR and severe TR was present in 14 (53.8%), 10 (38.4%) and 2 (7.7%) patients respectively. At follow up, only one (3.9%) patient had dilated RA and RV. Mean Tricuspid regurgitation pressure gradient decreased from mean 44.4 mmHg to 18.9 mmHg. Conclusion: Transcatheter Closure of Atrial Septal Defects with ³40 mm Septal Occluder is safe and effective in short term follow up.

Robotic, totally endoscopic atrial septal defect repair

Atrial septal defect accounts for 10–15% of congenital heart disease cases. Small-diameter atrial septal defects diagnosed during infancy or early adulthood are prone to spontaneous closure, whereas uncorrected, persistent moderate or large atrial septal defects can induce left-to-right shunting, which causes volume overload, heart failure, atrial arrhythmia, and/or pulmonary hypertension starting between the third and fourth decades of life. We describe in detail our technique for totally endoscopic, robotic-assisted atrial septal defect repair.

Safety and Cost Implications of Same-Day Discharge Following Elective Percutaneous Closure of Patent Foramen Ovale and Atrial Septal Defects in Australia

Background: Percutaneous closure of patent foramen ovale (PFO) and atrial septal defects (ASD) is being more commonly performed due to changes in international guidelines supporting its use. This study was performed to determine the clinical outcomes, safety and cost implications of same-day discharge (SDD) following such procedures and place this in an Australian context. Methods: This was a retrospective, observational study of patients undergoing elective percutaneous PFO or ASD closure at St. George Hospital, Australia between January 2011 and January 2020. Primary outcomes included 30-day major adverse cardiovascular endpoints (MACE) and readmission to hospital within 30 days. Results: Twenty-four patients were included in the primary analysis. Ten (41.7%) patients underwent elective ASD closure while 14 (58.3%) underwent PFO closure. Among the 24 patients who underwent elective percutaneous closure of structural heart disease, 23 patients (95.8%) were managed with SDD. There were no MACE outcomes at 30 days. No patients were re-admitted to hospital at 30 days following these procedures. When compared to overnight admission to hospital post-elective percutaneous structural heart condition closure, SDD yielded a cost saving of AUD 5999 per case. Conclusion: SDD following elective percutaneous closure of ASD and PFO was demonstrated to be a safe and effective strategy for managing patients. With more widespread use, it can lead to significant cost savings for hospitals without compromising patient care.