Long-Term Outcomes After Surgical Versus Transcatheter Closure of Atrial Septal Defects in Adults
Long-Term Outcomes After Surgical Versus Transcatheter Closure of Atrial Septal Defects in Adults
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DOI：
10.1016/j.jcin.2012.12.126
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发表时间：
2013-05-01
影响因子：
11.3
通讯作者：
Marelli, Ariane J.
中科院分区：
文献类型：
--
作者：
Kotowycz, Mark A.;Therrien, Judith;Marelli, Ariane J.
目的本研究的目的是评估成人继发性房间隔缺损（ASD）经导管封堵术与外科手术封堵术的比较有效性和长期安全性。背景在大多数工业化国家，经导管ASD封堵术已在很大程度上取代了外科手术，但比较两种技术的长期数据有限。方法我们对所有患者进行了一项回顾性人群队列研究，年龄在18至75岁之间，在加拿大第二大省魁北克进行手术或经导管ASD闭合的患者，使用省级行政数据库。主要结局为长期（5年）再干预和全因死亡率。次要结果是短期（1年）充血性心力衰竭，中风，或短暂性脑缺血发作的发病，和卫生服务use.Results的标记718 ASD关闭1988年和2005年之间进行，383是手术和335是经导管。经导管ASD封堵术患者的长期再介入率较高（5年时7.9% vs. 0.3%，p = 0.0038），但大多数再介入发生在第一年。经导管技术的长期死亡率并不劣于外科ASD闭合术（5年时5.3% vs. 6.3%，p = 1.00）。2组的次要结局相似。结论经导管ASD封堵术与较高的长期再介入率和长期死亡率相关，并不劣于手术。总体而言，这些数据支持在大多数合格患者中使用经导管ASD封堵的当前实践，并支持在症状变得明显之前对存在显著分流的ASD进行干预的决定。(C)2013年美国心脏病学会基金会
Objectives The purpose of this study was to assess the comparative effectiveness and long-termsafety of transcatheter versus surgical closure of secundum atrial septal defects (ASD) in adults.Background Transcatheter ASD closure has largely replaced surgery in most industrialized countries, but long-term data comparing the 2 techniques are limited.Methods We performed a retrospective population-based cohort study of all patients, ages 18 to 75 years, who had surgical or transcatheter ASD closure in Quebec, Canada's second-largest province, using provincial administrative databases. Primary outcomes were long-term (5-year) reintervention and all-cause mortality. Secondary outcomes were short-term (1-year) onset of congestive heart failure, stroke, or transient ischemic attack, and markers of health service use.Results Of the 718 ASD closures performed between 1988 and 2005, 383 were surgical and 335 were transcatheter. The long-term reintervention rate was higher in patients with transcatheter ASD closure (7.9% vs. 0.3% at 5 years, p = 0.0038), but the majority of these reinterventions occurred in the first year. Long-term mortality with the transcatheter technique was not inferior to surgical ASD closure (5.3% vs. 6.3% at 5 years, p = 1.00). Secondary outcomes were similar in the 2 groups.Conclusions Transcatheter ASD closure is associated with a higher long-term reintervention rate and long-term mortality that is not inferior to surgery. Overall, these data support the current practice of using transcatheter ASD closure in the majority of eligible patients and support the decision to intervene on ASD with significant shunts before symptoms become evident. (C) 2013 by the American College of Cardiology Foundation