Clinical outcomes of a combined transcatheter and minimally invasive atrial septal defect repair program using a 'Heart Team' approach

Abstract

Background: Contemporary transcatheter and minimally invasive approaches allow for improved cosmesis and eliminate sternotomy; however, access to a 'Heart Team' approach to minimally invasive atrial septal defect (ASD) repair remains limited in Canada. Methods: Retrospective chart review of all minimally invasive atrial septal defect repairs performed between 2009 and 2017 at a quaternary cardiac care centre were included. We compared residual shunt, functional status, periprocedural complications, and hospital lengths-of-stay between patients undergoing transcatheter and minimally invasive endoscopic ASD repair. Results: Between 2009 and 2017, 61 consecutive patients underwent ASD repair at a single centre: 28 patients underwent transcatheter closure (64.3% female, median age 57, interquartile range 43-70.5) and 33 patients underwent minimally invasive endoscopic repair (72.7% female, median age 37, interquartile range 24-50). Patient demographics were similar between the two groups with the exception of transcatheter patients having smaller defect size (1.65 cm versus 2.35 cm, p=0.002). Procedural success was 93% (26/28) and 100% (33/33) for transcatheter and minimally invasive groups (p=0.21), respectively. Periprocedural complications were similarly low between the two groups with the exception of longer hospital length-of-stay in the surgical patients (5 days vs 1 day, p<0.0001). Over a follow-up period (transcatheter: 0.5-56.5 months, surgical: 0.25-89 months), there was no difference in residual shunt (14.3% versus 6.1%, p=0.4) or NYHA I Functional Class (88.5% versus 96.9%, p=0.21). Conclusion: Transcatheter and minimally invasive approaches to ASD repair are safe and feasible in selected patients using a 'Heart Team' approach and represent attractive alternatives to median sternotomy.