Open-Chest Device Closure for the Minimally Invasive Management of Atrial Septal Defect in Young Children

Abstract

We integrated a catheter-based device and minimally invasive surgical techniques for the treatment of atrial septal defect for children younger than 2 years old. Forty-three patients were divided into 3 groups: group A underwent open-chest device closure with a right lateral thoracotomy (n = 12), group B underwent open-heart repair with a right lateral thoracotomy and cardiopulmonary bypass (n = 11), and group C underwent open-heart repair with a median thoracotomy and cardiopulmonary bypass (n = 20). Group A had the lowest weight (9.25 +/- 1.3 kg) and smallest defect size (10.25 +/- 3.9 mm). In group A, 2 patients had to be transitioned to open-heart repair after unsuccessful occlusion. Compared with the open-heart groups, the device group had a shorter total operation time (111 +/- 39 minutes), required the minimum amount of blood products (39 +/- 38 mL), and had a smaller amount of pleural drainage in the first 12 hours after the procedure (29 +/- 12 mL). All patients were discharged. The right ventricular end-diastolic diameter reduced significantly after the repair; furthermore, there was no difference in the size of reduction. However, the device group had the highest medical costs (30,639 +/- 3831 Chinese yuan). During the follow-up, there were no occluder-related complications observed in Group A, and there were no residual shunts or arrhythmia observed in the groups. The open-chest device closure was safely performed as a supplement for percutaneous treatment for young children.