Atrial Septal Defect Repair Research Articles

Abstract 13138: Outcomes of Surgical Repair for Sinus Venosus Atrial Septal Defect

Introduction: Sinus venosus atrial septal defect (SVASD) is a rare congenital cardiac anomaly comprising 5-10% of all atrial septal defects. Although surgical closure is the standard treatment for SVASD, data on outcomes have been confined to small cohorts. Thus, we conducted a systematic review and meta-analysis of outcomes of SVASD repair. Methods: A comprehensive search of PROSPERO, MEDLINE, EMBASE, and Cochrane Library databases was conducted. The primary outcome was mortality. Secondary outcomes encompassed atrial fibrillation, sinus node dysfunction, pacemaker insertion, cerebrovascular accident (CVA), reoperation, residual septal defect, superior vena cava (SVC) obstruction, and reimplanted pulmonary vein obstruction. Pooled incidences of outcomes were calculated using a random effects model. Results: Forty studies involving 1,292 patients who underwent SVASD repair were included. The majority were male (59.4%), with 92.9% presenting with associated pulmonary anomalous venous connection. The weighted mean ages were 18.6 ± 12.5 years, and the overall weighted mean follow-up period was 8.6 ± 10.4 years. In-hospital mortality rate was 0.24%, with a 30-day mortality of 0.56% reported in 720 patients. Incidences of atrial fibrillation, sinus node dysfunction, pacemaker insertion, and CVA over the long-term follow-up were 2% (1-3%), 4% (2-6%), 2% (1-2%), respectively. Reoperation, residual septal defect, SVC obstruction, and reimplanted pulmonary vein obstruction occurred in 1% (0-2%), 2% (2-2%), 1% (1-1%), and 2% (2-2%) surgeries, respectively. Conclusions: This is the first comprehensive analysis of outcomes following surgical repair of SVASD. The findings affirm the safety and effectiveness of surgical intervention, establishing a reference point for evaluating emerging transcatheter therapies. Comparable safety and efficacy profiles to surgical repair are essential for widespread adoption of transcatheter treatments.

Totally Endoscopic Atrial Septal Defect Repair on Beating Heart: Clinical Outcome and Single-Surgeon Learning Curve Experience.

To evaluate the safety and efficacy of the Hanoi ASD procedure, which is totally endoscopic surgery for atrial septal defect (ASD) repair on beating heart. In addition, the present study also aimed to analyze the learning curve for this procedure. From May 2016 to February 2023, 198 consecutive ASD patients weighing ≥20 kg were enrolled in the retrospective study. The Hanoi ASD procedure includes (1) unilateral or bilateral femoral arterial cannulation; (2) two or three 5 mm trocars and a 15 mm port; (3) ASD repair on beating heart, preventing air embolism with CO2 insufflation and keeping the left atrium full of blood; and (4) not snaring the inferior vena cava. Cumulative sum (CUSUM) analysis was used to evaluate the cardiopulmonary bypass (CPB) and operation time learning curves. Variables among the learning curve phases were compared. The CPB and operation times were 90 (72 to 115) min and 180 (150 to 220) min, respectively. Total drainage volume was 190 (120 to 290) mL. No endoscopic failure or major complications were recorded. After excluding factors causing bias, the CUSUMCPBtime analysis for the remaining 131 patients included 3 phases. Phase 1 was the initial learning period (cases 1 to 34), phase 2 represented the technical competence period (cases 35 to 54), and phase 3 was the challenging period (cases 55 to 131). The Hanoi ASD procedure is safe and feasible for repairing ASD in patients weighing ≥20 kg. According to the learning curve analysis, 34 cases were required to achieve technical efficiency, and 54 cases were required to address highly challenging cases.

Quality of life in patients after totally endoscopic atrial septal defect closure surgery

Background: Totally endoscopic atrial septal defect closure surgery was applied effectively and aesthetically. However, more specific assessments of the patient's quality of life after surgery are needed.[1]
 Methods: From June 2022 to August 2023, 47 patients after totally endoscopic atrial septal defect repair surgery were enrolled to evaluate quality of life before and 1-month after surgery using the SF-36 questionnaire.
 Results: 47 patients were an average age of 38.5 years old, and 72% of women. The overall quality of life SF-36 score was at a good level of 77.3. In particular, physical and mental health scores improved significantly after than before surgery, the difference was statistically significant, p<0,01. Occupation, history of comorbidities and surgical complications are related to poor quality of life after totally endoscopic atrial septal defect repair surgery with OR of 0.72 (0.52 - 0. 99); 0.24(0.06 – 0.98); and 0.08 (0.01 -0.78), respectively, with p<0.05.
 Conclusion: The quality of life of patients after totally endoscopic atrial septal defect repair surgery is significantly improved. Occupation, history of comorbidities, and surgical complications are some associated factors.

Right subaxillary muscle-sparing thoracotomy for less invasive open-heart surgery: flap-double patch repair of sinus venosus atrial septal defect and partially anomalous pulmonary venous drainage.

Right subaxillary muscle-sparing thoracotomy for less invasive open-heart surgery: flap-double patch repair of sinus venosus atrial septal defect and partially anomalous pulmonary venous drainage.

Comparing apples to apples: Exploring public reporting of congenital cardiac surgery outcomes based on common congenital heart operations

ObjectiveWe sought to simplify reporting of outcomes in congenital heart surgery that compares well-defined patient groups and accommodates multiple stakeholder needs while being easily understandable. MethodsWe selected 19 commonly performed congenital heart surgeries ranging in complexity from repair of atrial septal defects to the Norwood procedure. Strict inclusion/exclusion criteria ensured the creation of 19 well-defined diagnosis/procedure cohorts. Preoperative, procedural, and postoperative data were collected for consecutive eligible patients from 9 centers between January 1, 2016, and December 31, 2021. Unadjusted operative mortality rates and hospital length of stay for each of the 19 diagnosis/procedure cohorts were summarized in aggregate and stratified by each center. ResultsOf 8572 eligible cases included, numbers in the 19 diagnosis/procedure cohorts ranged from 73 for tetralogy of Fallot repair after previous palliation to 1224 for ventricular septal defect (VSD) repair for isolated VSD. In aggregate, the unadjusted mortality ranged from 0% for atrial septal defect repair to 28.4% for hybrid stage I. There was significant heterogeneity in case mix and mortality for different diagnosis/procedure cohorts across centers (eg, arterial switch operation/VSD, n = 7-42, mortality 0%-7.4%; Norwood procedure, n = 16-122, mortality 5.3%-25%). ConclusionsReporting of institutional case volumes and outcomes within well-defined diagnosis/procedure cohorts can enable centers to benchmark outcomes, understand trends in mortality, and direct quality improvement. When made public, this type of report could provide parents with information on institutional volumes and outcomes and allow them to better understand the experience of each program with operations for specific congenital heart defects.

Treatment of long-segment congenital tracheal stenosis with congenital cardiovascular defects in infancy.

This study aims to evaluate the outcomes of simultaneous repair for infants with long-segment congenital tracheal stenosis (LSCTS) with congenital cardiovascular defects (CCD). We retrospectively reviewed the clinical data of infants aged less than 1 year with LSCTS and CCD who underwent simultaneous repair at Children's Hospital of Chongqing Medical University from January 2020 to March 2023. A systematic search of PubMed, Embase, and Cochrane Library for the relevant published studies that reported the simultaneous repair of CTS and CCD in infancy was conducted in March 2023. The inverse variance method of DerSimonian-Laird (D+L) was used for estimate synthesis. A total of thirteen infants with a mean age of 5.6±3.1 months and a mean weight of 6.4±0.9Kg underwent slide tracheoplasty with modified procedures and cardiovascular operations. LSCTS was diagnosed in all thirteen patients. Nine infants were ventilator dependent, and four patients were operated on due to persistent wheezing and recurrent respiratory infections. Seven patients underwent pulmonary artery sling repair, and six underwent atrial septal defect repair. All infants were repaired utilizing cardiopulmonary bypass (CPB) support. Significant complications were recorded in three patients. In-hospital deaths were seen in one case. The median tracheal minimum diameter of hospital survivors was significantly larger than the preoperative minimum diameter (p<0.001). The mean follow-up duration was 17.1±7.1 months. There was no late mortality during the follow-up. Twelve studies were included based on our search strategy. The pooled estimate of mortality in the literature was 10.9% (95%CI, 5.3%-17.7%, I2=0). The pooled estimate of airway re-interventions was 28.8% (95%CI, 14.5%-43.2%, I2=74%). Simultaneous repair of LSCTS and CCD in infancy is safe and effective. Slide tracheoplasty with appropriate technical modifications may be valid for LSCTS repair without significant restenosis and reinterventions.

Effective and aesthetic results of horizontal right axillary minithoracotomy for congenital heart defects repair in children

Background: horizontal right axillary minithoracotomy is one of the treatment options for many simple congenital heart defects. This approach shows many aesthetic advantages besides effectiveness and safety. This study aims to: comment on the technical characteristics and early results of horizontal right axillary minithoracotomy in children at Hanoi Heart Hospital.&#x0D; Methods: a descriptive cross-sectional study. We retrospectively reviewed 156 patients who underwent horizontal right axillary minithoracotomy at Hanoi Heart Hospital from January 2022 to December 2022.&#x0D; Results: horizontal axillary approach could be applied even for children with low weight, average weight was 12.22 ± 8.67 kg, the lowest was 2.6 kg and the highest was 51.0 kg. A wide range of congenital heart defects were repaired, including ventricular septal defect closure (84 patients), secundum atrial septal defect closure (22 patients), ventricular septal defect with stenosis repair (31 patients), partial atrio-ventricular septal canal repair (6 patients), repair of atrial septal defect with partial abnormal return of the pulmonary veins (3 patients), repair of ventricular septal defect and atrial septal defect (4 patients), Cor triatriatum sinister repair (4 patients), mitral valve repair (1 patient), atrial septal defect and pulmonary valve stenosis repair (1 patient). Cannulation of the aorta and vena cavae was performed through the main incision, whose size ranged from 3.5 to 5.5cm. The average postoperative hospital stay was 7.34 ± 2.16 days, the rate of severe complications and hospital mortality were 0%.&#x0D; Conclusion: horizontal right axillary minithoracotomy was a good approach to correct many simple congenital heart defects in children. This technique is being applied at Hanoi Heart Hospital safely and provided outstanding advantages in terms of aesthetics.

Post-Cardiac Injury Syndrome (Dressler Syndrome) Following Atrial Septal Defect (ASD) Repair: a Case Report

Dressler syndrome is a type of secondary pericarditis that can be accompanied by pleural effusion or pericardial effusion resulting from injury of the pericardium or heart tissue. A 33-year-old male was admitted to the emergency department with pleuritic chest pain radiating to both shoulders and fever. Two months before the admission, the patient underwent traditional open-heart surgery with median sternotomy and pericardiectomy for atrial septal defect (ASD) closure. Blood tests showed elevated acute phase reactants (leukocytosis, high erythrocyte sedimentation rate, and C-reactive protein). Left-sided pleural effusion was revealed on chest CT scan. Diagnosis of Dressler syndrome was established. The patient’s pleuritic chest pain and shoulder pain improved clinically with a short course of colchicine. Although Dressler syndrome is rarely seen, it should be considered in the differential diagnosis of pleuritic chest pain. Special attention should be paid to Dressler’s syndrome because pericarditis can develop following cardiac surgery.

Iatrogenic injury of aortic valve leaflet during mitral valve replacement: A transesophageal echocardiographic finding

Iatrogenic aortic valve injury during non-aortic cardiac surgery is an infrequent complication. Iatrogenic aortic regurgitation (AR) has been reported after mitral valve repair, aortic valve repair, septal myomectomy, closure of the ventricular septal defect, and atrial septal defect repair. Various causes have been reported for AR after non-aortic cardiac surgery. Perforation of the aortic valve leaflet is a common cause of AR. Other causes of AR are leaflet tension and leaflet retraction due to inadvertent suture placement. A few previous case reports have presented severe AR as a complication of iatrogenic involvement of aortic valve leaflet during MV surgery. We report a case of severe AR and severe aortic stenosis occurring immediately after mitral valve replacement. This was diagnosed intraoperatively by Transesophageal echocardiography (TEE) and aortic valve replacement was done.

Evaluating variation in pre-operative evaluation and planning for children undergoing atrial or ventricular septal defect repair.

CHD care is resource-intensive. Unwarranted variation in care may increase cost and result in poorer health outcomes. We hypothesise that process variation exists within the pre-operative evaluation and planning process for children undergoing repair of atrial septal defect or ventricular septal defect and that substantial variation occurs in a small number of care points. From interviews with staff of an integrated congenital heart centre, an initial process map was constructed. A retrospective chart review of patients with isolated surgical atrial septal defect and ventricular septal defect repair from 7/1/2018 through 11/1/2020 informed revisions of the process map. The map was assessed for points of consistency and variability. Thirty-two surgical atrial septal defect/ventricular septal defect repair patients were identified. Ten (31%) were reviewed by interventional cardiology before surgical review. Of these, 6(60%) had a failed catheter-based closure and 4 (40%) were deemed inappropriate for catheter-based closure. Thirty (94%) were reviewed in case conference, all attended surgical clinic, and none were admitted prior to surgery. The process map from interviews alone identified surgery rescheduling as a point of major variability; however, chart review revealed this was not as prominent a source of variability as pre-operative interventional cardiology review. Significant variation in the pre-operative evaluation and planning process for surgical atrial septal defect/ventricular septal defect patients was identified. If such process variation is widespread through CHD care, it may contribute to variations in outcome and cost previously documented within CHD surgery. Future research will focus on determining whether the variation is warranted or unwarranted, associated health outcomes and cost variation attributed to these variations in care processes.

PO-03-136 PERCUTANEOUS RETRIEVAL OF ACUTE AMULET LAA OCCLUDER MALPOSITION OR DISLODGEMENT

Device embolization with the Amulet LAA occluder was rare (0.7%) in the Amulet IDE trial. Percutaneous techniques to retrieve embolized devices are poorly characterized. To describe a technique for percutaneous retrieval of malpositioned/embolized Amulet devices. We present 2 cases of acute Amulet malposition/embolization and subsequent percutaneous retrieval. Case 1: 78 y/o male with an electrically isolated LAA after AF ablation underwent LAAO with TEE guidance. The LAA landing zone width was measured as 29 mm, so a 31 mm Amulet was deployed uneventfully. A same-day echocardiogram revealed device dislodgement into the LA. Patient was brought back to the EP lab in stable condition. A retrieval system (23 Fr Micra sheath, Agilis steerable sheath and a Raptor forceps) was positioned in the right atrium (RA). Under TEE and fluoroscopic guidance, the Raptor catheter with the Agilis sheath was advanced into the LA through the Micra sheath and prior transseptal puncture. The Micra sheath was positioned to support the interatrial septum from the RA side, while the Raptor catheter and Agilis were used to capture the device and withdraw it into the RA, into Micra sheath and then removed from the body. Reassessment of the landing zone width led to successful deployment of a 25 mm Amulet. Case 2: 61 y/o female with ASD repair, prior AF ablations, two TIAs on anticoagulation underwent LAAO with ICE guidance. A 25 mm Amulet was deployed, but within minutes of deployment, the device acutely shifted in the LAA to a suboptimal position. A Raptor catheter was advanced via the Amulet steerable sheath into the LA, and the device was recaptured and brought into the RA; however, when trying to withdraw into the sheath, it disengaged from the Raptor catheter. Subsequently, the Amulet sheath was exchanged for the previously described retrieval system. The Amulet was recaptured in the RA, but due to unfavorable position, it couldn’t be brought into the Micra sheath. Another retrieval system was inserted into the RA via the contralateral femoral vein. One Raptor catheter was used to stabilize the Amulet, while the other one captured it in a favorable position and successfully withdrew into the Micra sheath. A 27 mm Watchman device was subsequently successfully implanted. Both patients were discharged from the hospital without other complications. Amulet dislodgement from the LAA is rare, but when it happens, it can be safely and effectively managed by percutaneous techniques.

AN ACCIDENTALLY DIAGNOSED CASE OF SINUS VENOSUS TYPE OF ATRIAL SEPTAL DEFECT

Atrial septal defect (ASD) is the most common congenital heart lesion in adults and is often asymptomatic until adulthood. Diagnosis is important, as timely ASD repair improves outcomes.

Unrecognized Patent Foramen Ovale in Patient With Sinus Venosus-Type Atrial Septal Defect With Partial Anomalous Pulmonary Venous Return.

Unrecognized Patent Foramen Ovale in Patient With Sinus Venosus-Type Atrial Septal Defect With Partial Anomalous Pulmonary Venous Return.

Efficacy and safety of robotic-assisted versus median sternotomy for cardiac surgery: results from a university affiliated hospital.

We aimed to report the experience of robotic-assisted cardiac surgery (RACS) using the Da Vinci robotic surgical system, meanwhile its efficacy and safety was also evaluated by comparing with traditional open-heart surgery (TOHS), thus to provide evidence for a broader application of RACS in clinical practice. From July 2017 to May 2022, a total of 255 patients who underwent cardiac surgery assisted by Da Vinci robotic surgery system in the First Affiliated Hospital of Anhui Medical University, which included 134 males with an average age of 52.6±6.3 years and 121 females with an average age of 51.8±5.4 years. They were defined as the RACS group. By searching the hospital's electronic medical record information system, 736 patients with the same disease types who underwent median sternotomy and had complete data in the same period were selected as the TOHS group. Intra- and postoperative clinical results of the both groups were compared, and we focused the following indices including surgery time, reoperation rate for postoperative bleeding, length of intensive care unit (ICU) stay, postoperative hospitalization day, the number of died and withdrawing treatments, and the time of patients back to normal daily activities after discharge. In RACS group, 2 patients were scheduled to undergo mitral valvuloplasty (MVP), but they had to change to mitral valve replacement (MVR) due to unsatisfactory results; furthermore, 1 patient who received atrial septal defect (ASD) repair experienced abdominal hemorrhage because a rupture of abdominal aorta which were induced by the femoral arterial cannulation, and this patient eventually died of invalid rescue. As for the comparison of clinical results between both groups, there were no significant statistical differences in reoperation rate for postoperative bleeding, and the number of died and withdrawing treatments between both groups. However, length ICU stay, postoperative hospitalization day, and the time of patients back to normal daily activities after discharge was lower in RACS group in addition to the surgery time. Compared with TOHS, RACS is safe and effective in clinical and is worthy of promotion in an appropriate place.

Simultaneous Live Donor Liver Transplantation, Aortic Valve Replacement, and Atrial Septal Defect Repair in a Patient With End Stage Liver Disease: A Case Report

Valvular heart disease creates an important barrier for orthotopic liver transplantation in patients with end-stage liver disease and increases mortality. Selection of the appropriate surgical scheme and adequate postoperative management can be lifesaving in these cases. This study presents a 32-year-old man diagnosed with hepatitis C-associated cirrhosis and severe aortic regurgitation due to subacute bacterial endocarditis. Initially, simultaneous aortic valve replacement (AVR) and live donor liver transplantation (LDLT) was planned. However, intraoperative transesophageal echocardiography revealed an additional atrial septal defect (ASD) and AVR, ASD repair, and LDLT surgery were performed. During the 2-year follow-up period, there were no early or late complications. To the best of our knowledge, this is the first patient to have simultaneous AVR, ASD repair, and LDLT surgery. Additionally, the present case is also unique in being the first person in the Republic of Azerbaijan to undergo concomitant cardiac surgery and LDLT.

Assessing Risk Factors for Prolonged Intensive Care Unit Stay After Surgery for Adult Congenital Heart Disease: A Study From a Lower-Middle-Income Country.

Background Prolonged post-surgery intensive care unit (ICU) stay for congenital heart disease (CHD) has been explored in the pediatric population. However, there is limited data for adult CHD (ACHD), also called grown-up congenital heart (GUCH) disease, especially in low-resource countries where intensive care beds are scarce. This study identifies factors associated with prolonged ICU stay following surgery for ACHD in Pakistan, a lower-middle-income country (LMIC). Methods This retrospective study included all adult patients (⩾18 years) who underwent cardiac surgery with cardiopulmonary bypass for their CHD from 2011-2016 at a tertiary-care private hospital in Pakistan. Prolonged ICU stay was defined as stay >6 days (75th percentile). Regression analysis was used to explore risk factors of prolonged ICU stay. Results A total of 166 patients (53.6% males) with a mean age of 32.05 ± 12.11 years were included. Atrial septal defect repair was the most common surgery (42.2%). Most patients were categorized as Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1) Category 1 (51.8%) and Category 2 (30.1%). Forty-three of 166 patients (25.9%) experienced prolonged ICU stay. Complications occurred in 38.6% of patients postoperatively, with the most common being acute kidney injury (29.5%). On multivariable logistic regression adjusted for age, gender, and RACHS-1 categories, intraoperative inotrope score, cardiopulmonary bypass time, aortic cross-clamp time duration of mechanical ventilation, and postoperative acute kidney injury (AKI) were associated with prolonged ICU stay. Conclusion Surgeons managing ACHD in LMICs must strive for shorter operative durations and the judicious use of intraoperative inotropes in addition to anticipating and promptly managing postoperative complications such as AKI, to minimize ICU stay in countries where intensive care beds are a scarce resource.

Comparison between minimal invasive thoracotomy and standard median sternotomy for repair of atrial septal defects

Comparison between minimal invasive thoracotomy and standard median sternotomy for repair of atrial septal defects

A Web-Based Synchronized Architecture for Collaborative Dynamic Diagnosis and Therapy Planning

Clinical treatment delivery often involves multiple medical professionals, where collaborative teamwork is crucial to ensure the quality of diagnosis and therapeutic decision making. With the development of Internet of Medical Things (IoMT) and its applications in mobile health (mHealth), healthcare services can be delivered to remote users. However, a challenging situation arises when the data are volumetric and dynamic, it will be difficult to achieve real-time performance in information streaming and data dynamic rendering and synchronization over Internet, as is the case with cardiac procedures, where both the anatomy and dynamic function characteristics of the organ must be considered. To address this issue, we have developed new algorithms and a web-based collaborative software architecture to display dynamic volumetric data in a web browser to enable dynamic data sharing with remote healthcare professionals. We illustrate our system using the diagnosis and treatment planning of an atrial septal defect (ASD) repair as an example to evaluate the capabilities of our platform. In this example, a series of three-dimensional (3D) ultrasound images are registered and fused with the high-quality magnetic resonance (MR) cardiac data to provide complementary information; virtual septal occluder patches are modeled and integrated into the beating heart views to facilitate the planning of the procedure to occlude the ASD, and feedback is streamed amongst all participating professionals. Our algorithm runs on a Node.js server with WebSocket protocol to synchronize dynamic heart rendering, so all the connected users can observe the same four-dimensional (4D) display of the dual-modality heart data during the process of examining cardiac anatomy, performing functional analysis, and sharing treatment strategies across distributed geographic locations. The presented computational models and software architecture create a new vehicle for collaborative exploration and manipulation of dynamic volumetric medical datasets.

The case of a buffalo chest in a pediatric patient with a history of Atrial Septal Defect repair

The case of a buffalo chest in a pediatric patient with a history of Atrial Septal Defect repair

Simultaneous minimally invasive uniportal atrial septal defect repair and pulmonary lobectomy: a case report.

Combination of non-oncological pulmonary and cardiac conditions is common entity in modern thoracic surgery, allowing concurrent surgical correction. Multiple publications in the literature address the success of simultaneous interventions for combined conditions, however almost all are performed with an open approach. A 49-year-old male with past medical history significant for bronchiectasis, complicated by fibrosis of the middle lobe, presented with dyspnea, recurrent hemoptysis, and nonproductive cough. Echocardiography revealed a large atrial septal defect (ASD), biventricular enlargement with severe mitral and tricuspid regurgitation. After multidisciplinary evaluation, patient was taken to the operating room for simultaneous cardiac intervention with right middle lobectomy. The total duration of surgery was 332 min, with cross-clamp time of 79 min. Estimated blood loss was 800 mL. Patient was extubated 3 h postoperatively, chest tube was removed on postoperative day 4 and the patient was discharged home on postoperative day 8 without postoperative complications. In this article, we describe the first case of simultaneous thoracoscopic uniportal intervention with cardiopulmonary bypass (CPB) in the treatment of multiple congenital heart defects and pulmonary complications of bronchiectasis. Presented case demonstrates potential advantage and feasibility of minimally invasive simultaneous procedures in patients with concurrent pulmonary and cardiac conditions. The described approach allowed radical surgical intervention to address both problems in the single setting, while retaining advantage of minimally invasive intervention.