Minimally invasive or interventional repair of atrial septal defects in children: experience in 171 cases and comparison with conventional strategies

OBJECTIVES The goal of this study was to evaluate percutaneous interventional and minimally invasive surgical closure of secundum atrial septal defect (ASD) in children. BACKGROUND Concern has surrounded abandoning conventional midline sternotomy in favor of the less invasive approaches pursuing a better cosmetic result and a more rational resource utilization. METHODS A retrospective analysis was performed on the patients treated from June 1996 to December 1998. RESULTS One hundred seventy-one children (median age 5.8 years, median weight 22.1 kg) underwent 52 device implants, 72 minimally invasive surgical operations and 50 conventional sternotomy operations. There were no deaths and no residual left to right shunt in any of the groups. The overall complication rate causing delayed discharge was 12.6% for minimally invasive surgery, 12.0% for midline sternotomy and 3.8% for transcatheter device closure (p < 0.01). The mean hospital stay was 2.8 ± 1.0 days, 6.5 ± 2.1 days and 2.1 ± 0.5 days (p < 0.01); the skin-to-skin time was 196 ± 43 min, 163 ± 46 min and 118 ± 58 min, respectively (p < 0.001). Extracorporeal circulation time was 49.9 ± 10.1 min in the minithoracotomy group versus 37.2 ± 13.8 min in the sternotomy group (p < 0.01) but without differences in aortic cross-clamping time. Sternotomy was the most expensive procedure (15,000 € ± 1,050€ vs. 12,250 € ± 472 € for minithoracotomy and 13,000€ ± 300€ for percutaneous devices). CONCLUSIONS While equally effective compared with sternotomy, the cosmetic and financial appeal of the percutaneous and minimally invasive approaches must be weighed against their greater exposure to technical pitfalls. Adequate training is needed if a strategy of surgical or percutaneous minimally invasive closure of ASD in children is planned in place of conventional surgery.