Surgical ASD Closure After Interventional Occluder Placement - Incidence And Outcome
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Objective
Closure of simple type II atrial septal defects (ASD) is being performed using an interventional approach. We evaluated the outcome of some patients requiring secondary surgical therapy later on.
Methods
From 9/96 onwards 418 patients received interventional, 297 patients received surgical ASD closure at our center. 17 patients were referred for elective surgery after unsuccessful occluder attempts. Another 14 patients (local and other referrals) had complications after unsuccessful occluder placement.
Results
Indication for surgical repair in these 14 patients was dislocation of the occluder in 5, residual defects in 6, neurological events post occluder placement in 2 and sepsis with questionable occluder infection in 1 patient, respectively. A total of 7 patients had suffered neurological events, 5 of embolic origin. The interval between interventional occluder placement and definitive surgical repair was 276 ±409 days [range 0 - 1395]. Patient age at operation was 36 ±20 years. 8 patients were operated using an anterolateral minithoracotomy, 6 received a conventional sternotomy due to additional diseases. One patient with sepsis received abdominal surgery on postoperative day 1 and subsequently died, there was no proof for occluder endocarditis. At 2.5 ±1.9year follow-up all other patients had returned to full work without residual neurological impairment.
Conclusions
Complications may arise after interventional ASD closure. This has to be evaluated against the extremely low risk of a standard surgical procedure with more than 50 years of clinical experience. The functional outcome after secondary surgical ASD closure with removal of an occluder system is excellent.
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