Outcomes following surgical closure of secundum atrial septal defect in children < 15 kg – A dual center experience

Abstract

In children with a body weight < 15 kg, secundum ASD closure is usually achieved through a surgical approach as their low weight may expose them to a higher risk of complications associated with percutaneous closure. However, reports about the outcome following surgical ASD closure in children < 15 kg are scarce. Medical records of all children < 15 kg who underwent isolated secundum ASD surgical closure between 2010 and 2017 in 2 French tertiary centers (Bordeaux University Hospital, Necker Hospital, Paris, France) were reviewed retrospectively. Fifty-six children were included (mean age 19 ± 10 months and mean weight 9 ± 3 kg at time of surgery). The mean ASD size was 17 ± 4 mm. Indications for surgical closure were the right heart enlargement (56/56, 100%), failure to thrive (26/56, 46.4%), dyspnea (18/56, 32.1%) and recurrent respiratory infections (7/56, 12.5%). Thirteen children (23%) underwent cardiac catheterization before surgery which showed a mean Qp/Qs of 2.3 ± 0.7 and mean RVPi of 1.3 ± 0.8 UW.m 2 . The surgical approach was sternotomy in 83.9% of cases (mean duration of extracorporeal circulation = 61 ± 3 and aortic cross-clamping = 23 ± 8 minutes). The mean duration of hospital stay was 7 ± 5 days. No complications were observed during the perioperative period. After discharge, 54/56 (96.4%) were asymptomatic in the first month. After a median follow-up of 8 months (range: 0–90), no long-term complications were noted. Surgical closure of a secundum ASD in children < 15 kg of body weight is a safe technique which allows clinical improvement of patients. Randomized and comparative studies between surgery and catheterization are needed to assess the value of percutaneous closure in this population.