Transcatheter versus surgical closure of secundum atrial septal defect in adults: impact of age at intervention. A concurrent matched comparative study.
Transcatheter versus surgical closure of secundum atrial septal defect in adults: impact of age at intervention. A concurrent matched comparative study.
复制标题
成人继发孔房间隔缺损的经导管与手术闭合：干预时年龄的影响。
作者：
M. Rosas;C. Zabal;J. García;A. Buendía;G. Webb;F. Attié
目标
比较对于具有非常相似疾病谱的成人，使用 Amplatzer 房间隔封堵器 (ASO) 进行手术 (SUR) 与经导管封堵继发孔房间隔缺损 (ASD) 的短期和中期结果；并确定主要终点的预测因素。
设计
单中心、并行比较研究。接受手术治疗的患者按年龄、性别、手术日期、ASD 大小和血流动力学特征进行随机匹配 (2:1)。
设置
三级转诊中心。
患者
162 名并发 ASD 患者根据自己的意愿接受 ASO (n = 54) 或 SUR 封闭 (n = 108)。
主要成果指标
主要终点是主要事件的综合指数，包括手术失败、严重出血、严重心律失常、严重感染、栓塞或任何主要心血管干预相关并发症。对这些重大事件的预测因素进行了调查。
结果
所有患者房间隔缺损均成功闭合，无死亡病例。 ASO 的主要事件发生率为 13.2%，而 SUR 的主要事件发生率为 25.0% (P = .001)。多变量分析显示，较高的事件发生率与年龄 >40 岁显着相关；全身/肺输出量比<2.1；肺动脉收缩压>50毫米汞柱；而在 ASO 组中，事件发生率仅与 ASD 大小相关（>15 cm(2)/m(2)；相对风险 = 1.75，95% 置信区间 1.01-8.8）。年龄<40岁的成年人的无事件生存曲线没有差异。
结论
两组封闭 ASD 的疗效相似。 SUR 组中观察到的较高发病率仅在年龄 > 40 岁接受手术的患者中观察到。 ASO 组的住院时间较短。手术闭合是一种安全有效的治疗方法，尤其是对于年轻人。在资源有限的国家继续做手术当然没有错。
OBJECTIVES
To compare the short- and mid-term outcomes of surgical (SUR) vs. transcatheter closure of secundum atrial septal defect (ASD) using Amplatzer septal occluder (ASO) in adults with a very similar spectrum of the disease; and to identify predictors for the primary end point.
DESIGN
Single-center, concurrent comparative study. Surgically treated patients were randomly matched (2:1) by age, sex, date of procedure, ASD size, and hemodynamic profile.
SETTING
Tertiary referral center.
PATIENTS
One hundred sixty-two concurrent patients with ASD submitted to ASO (n = 54) or SUR closure (n = 108) according with their preferences.
MAIN OUTCOME MEASURES
Primary end point was a composite index of major events including failure of the procedure, important bleeding, critical arrhythmias, serious infections, embolism, or any major cardiovascular intervention-related complication. Predictors of these major events were investigated.
RESULTS
Atrial septal defects were successfully closed in all patients, and there was no mortality. The primary event rate was 13.2% in ASO vs. 25.0% in SUR (P = .001). Multivariate analysis showed that higher rate of events was significantly associated with age >40 years; systemic/pulmonary output ratio <2.1; and systolic pulmonary arterial pressure >50 mm Hg; while in the ASO group the event rate was only associated with the ASD size (>15 cm(2)/m(2); relative risk = 1.75, 95% confidence interval 1.01-8.8). There were no differences in the event-free survival curves in adults with ages <40 years.
CONCLUSIONS
The efficacy for closure ASD was similar in both groups. The higher morbidity observed in SUR group was observed only in the patients submitted to the procedure with age >40 years. The length of hospital stay was shorter in the ASO group. Surgical closure is a safe and effective treatment, especially in young adults. There is certainly nothing wrong with continuing to do surgery in countries where the resources are limited.