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Surgical Closure of Secundum Atrial Septal Defects: the Cutting Edge?

Division of Cardiovascular and Thoracic Surgery British Columbia's Children's Hospital Vancouver, British Columbia, Canada
For reprint information contact: Jacques G LeBlanc, MD Tel: 1 604 875 3165 Fax: 1 604 875 3159 email: jleblanc{at}dowco.com Division of Cardiovascular and Thoracic Surgery, British Columbia's Children's Hospital, Suite 3G63, 4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada.

Between January 1985 and November 1998, 270 patients (aged 2 to 220 months) underwent surgical closure of a secundum atrial septal defect. Cardiopulmonary bypass times ranged from 12 to 103 minutes, with aortic crossclamp times of 5 to 49 minutes. Use of blood products decreased from 2.7 units per patient in the first 5 years to 0.2 units in the last 4 years. Median intensive care unit and hospital stays were 2 days and 6 days, respectively. Complications included: bleeding in 6 patients (2%), which required reexploration in 3; air embolism in 1; and arrhythmias in 4. Postpericardiotomy syndrome occurred in 43 patients (16%), requiring drainage in 5. Follow-up (12 to 179 months) was available in 245 patients (91%). There were no early or late deaths. Most patients (94%) were in sinus rhythm, 8 had low atrial rhythm, 3 had first-degree atrioventricular block, and 1 had atrial flutter. Echocardiography in 207 patients (77%) demonstrated a residual shunt in 1 (0.5%), which was hemodynamically insignificant. Late reoperation was required in 4 patients for sternal nonunion. Surgical closure of secundum atrial septal defect remains the gold standard with which transcatheter closure should be compared, particularly with reference to morbidity and residual shunts.