Author + information
- Received July 27, 2012
- Revision received November 26, 2012
- Accepted December 21, 2012
- Published online May 1, 2013.
- Mark A. Kotowycz, MD, MBA⁎,
- Judith Therrien, MD⁎,
- Raluca Ionescu-Ittu, PhD⁎,†,
- Colum G. Owens, MD⁎,
- Louise Pilote, MD, MPH, PhD†,‡,
- Giuseppe Martucci, MD⁎,
- Christo Tchervenkov, MD⁎ and
- Ariane J. Marelli, MD, MPH⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Ariane Marelli, McGill Adult Unit for Congenital Heart Disease Excellence, McGill University Health Centre, 687 Pine Avenue West, Room H4.33, Montréal, Québec H3A 1A1, Canada
Objectives The purpose of this study was to assess the comparative effectiveness and long-term safety of transcatheter versus surgical closure of secundum atrial septal defects (ASD) in adults.
Background Transcatheter ASD closure has largely replaced surgery in most industrialized countries, but long-term data comparing the 2 techniques are limited.
Methods We performed a retrospective population-based cohort study of all patients, ages 18 to 75 years, who had surgical or transcatheter ASD closure in Québec, Canada's second-largest province, using provincial administrative databases. Primary outcomes were long-term (5-year) reintervention and all-cause mortality. Secondary outcomes were short-term (1-year) onset of congestive heart failure, stroke, or transient ischemic attack, and markers of health service use.
Results Of the 718 ASD closures performed between 1988 and 2005, 383 were surgical and 335 were transcatheter. The long-term reintervention rate was higher in patients with transcatheter ASD closure (7.9% vs. 0.3% at 5 years, p = 0.0038), but the majority of these reinterventions occurred in the first year. Long-term mortality with the transcatheter technique was not inferior to surgical ASD closure (5.3% vs. 6.3% at 5 years, p = 1.00). Secondary outcomes were similar in the 2 groups.
Conclusions Transcatheter ASD closure is associated with a higher long-term reintervention rate and long-term mortality that is not inferior to surgery. Overall, these data support the current practice of using transcatheter ASD closure in the majority of eligible patients and support the decision to intervene on ASD with significant shunts before symptoms become evident.
Dr. Kotowycz has received speaker fees/honoraria from St. Jude Medical, the company that owns the Amplatzer Septal Occluder. Dr. Ionescu-Ittu is currently employed by Analysis Group, a research consultancy company; at the time of this project, she was with McGill Adult Unit for Congenital Heart Disease Excellence. Dr. Owens is supported by the Beth Raby Adult Congenital Heart Disease Fellowship of the Jewish General Hospital. Drs. Owens, Pilote, and Marelli are supported by the Fonds de la Recherche en Santé du Québec. Dr. Marelli is supported by the Heart and Stroke Foundation and the Canadian Institutes of Health Research. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 27, 2012.
- Revision received November 26, 2012.
- Accepted December 21, 2012.
- American College of Cardiology Foundation