1
|
Wang J, Xie W, Cheng M, Wu Q, Wang F, Li P, Fan B, Zhang X, Wang B, Liu X. Assessment of Transcatheter or Surgical Closure of Atrial Septal Defect using Interpretable Deep Keypoint Stadiometry. RESEARCH (WASHINGTON, D.C.) 2022; 2022:9790653. [PMID: 36340508 PMCID: PMC9620637 DOI: 10.34133/2022/9790653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/03/2022] [Indexed: 12/01/2023]
Abstract
Automated echocardiogram interpretation with artificial intelligence (AI) has the potential to facilitate the serial diagnosis of heart defects by primary clinician. However, the fully automated and interpretable analysis pipeline for suggesting a treatment plan is largely underexplored. The present study targets to build an automatic and interpretable assistant for the transthoracic echocardiogram- (TTE-) based assessment of atrial septal defect (ASD) with deep learning (DL). We developed a novel deep keypoint stadiometry (DKS) model, which learns to precisely localize the keypoints, i.e., the endpoints of defects and followed by the absolute distance measurement with the scale. The closure plan and the size of the ASD occluder for transcatheter closure are derived based on the explicit clinical decision rules. A total of 3,474 2D and Doppler TTE from 579 patients were retrospectively collected from two clinical groups. The accuracy of closure classification using DKS (0.9425 ± 0.0052) outperforms the "black-box" model (0.7646 ± 0.0068; p < 0.0001) for within-center evaluation. The results in cross-center cases or using the quadratic weighted kappa as an evaluation metric are consistent. The fine-grained keypoint label provides more explicit supervision for network training. While DKS can be fully automated, clinicians can intervene and edit at different steps of the process as well. Our deep learning keypoint localization can provide an automatic and transparent way for assessing size-sensitive congenital heart defects, which has huge potential value for application in primary medical institutions in China. Also, more size-sensitive treatment planning tasks may be explored in the future.
Collapse
Affiliation(s)
- Jing Wang
- School of Basic Medical Sciences, Capital Medical University, Beijing 10069, China
| | - Wanqing Xie
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei 230032, China
- Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA 02215, USA
| | - Mingmei Cheng
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei 230032, China
| | - Qun Wu
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 10045, China
| | - Fangyun Wang
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 10045, China
| | - Pei Li
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 10045, China
| | - Bo Fan
- School of Basic Medical Sciences, Capital Medical University, Beijing 10069, China
| | - Xin Zhang
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 10045, China
| | - Binbin Wang
- Center for Genetics, National Research Institute for Family Planning, Beijing 100730, China
- Graduated school, Peking Union Medical College, Beijing 100730, China
| | - Xiaofeng Liu
- Gordon Center for Medical Imaging, Harvard Medical School, and Massachusetts General Hospital, Boston, MA 02114, USA
| |
Collapse
|
2
|
Turner ME, Bouhout I, Petit CJ, Kalfa D. Transcatheter Closure of Atrial and Ventricular Septal Defects: JACC Focus Seminar. J Am Coll Cardiol 2022; 79:2247-2258. [PMID: 35654496 DOI: 10.1016/j.jacc.2021.08.082] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
The field of congenital interventional cardiology has experienced tremendous growth in recent years. Beginning with the development of early devices for transcatheter closure of septal defects in the 1970s and 1980s, such technologies have evolved to become a mainstay of treatment for many atrial septal defects (ASDs) and ventricular septal defects (VSDs). Percutaneous device closure is now the preferred approach for the majority of secundum ASDs. It is also a viable treatment option for selected VSDs, though limitations still exist. In this review, the authors describe the current state of transcatheter closure of ASDs and VSDs in children and adults, including patient selection, procedural approach, and outcomes. Potential areas for future evolution and innovation are also discussed.
Collapse
Affiliation(s)
- Mariel E Turner
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA.
| | - Ismail Bouhout
- Division of Cardiothoracic Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA
| | - Christopher J Petit
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA
| | - David Kalfa
- Division of Cardiothoracic Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
3
|
Naser N, Hadziomerovic N, Avdic S. Transcatheter Device Closure of Secundum Atrial Septal Defect in Adult Patient. Acta Inform Med 2021; 29:65-68. [PMID: 34012216 PMCID: PMC8116089 DOI: 10.5455/aim.2021.29.65-70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Atrial septal abnormalities are common congenital lesions remaining asymptomatic until adulthood in a great number of patients. The most frequent atrial septal defects in adults are ostium secundum atrial septal defect (ASD). Complications from untreated, hemodynamically significant ASD are atrial arrhythmia, paradoxical embolization, Eisenmenger’s syndrome, pulmonary hypertension, and right ventricular failure. Objective: We present a case report of secundum ASD in adult female patient who underwent transcatheter device closure with Amplatzer occluder. Methods and Results: The case of female Bosnian patient 50 years old who lives in Belgium for 20 years ago and during her visit to Bosnia she came to our polyclinic for cardiological exam. Echocardiographic exam showed enlargement of left atrium (LAD 51mm), right atrium and ventricle (RAD 46mm, RVd 33mm), atrial septal defect 9mm with left right shunt Qp:Qs 2,3:1. Several months later transcatheter device closure with Amplatzer occluder was performed and subsequent symptomatic improvement reported after closure. Conclusion: Echocardiography has superior role for precise evaluation of ASD type secundum who are suitable for transcatheter device closure as primary treatment option. Transcatheter techniques has now become preferable to surgical repair and provide valid option of treatment for this type of CHD.
Collapse
Affiliation(s)
- Nabil Naser
- Polyclinic "Dr. Nabil", Sarajevo, Bosnia and Herzegovina
| | | | - Sevleta Avdic
- Medical Institute Bayer, Tuzla, Bosnia and Herzegovina
| |
Collapse
|
4
|
Xie X, Tang M, Kahn-Krell A, Qin K, Yang J, Fan C. A large congenital atrial septal defect in an adult with delayed therapy. J Int Med Res 2021; 49:300060521997700. [PMID: 33719647 PMCID: PMC7952845 DOI: 10.1177/0300060521997700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patients with a large congenital atrial septal defect (ASD) traditionally have the ASD repaired at the preschool age. Unfortunately, insufficient education of patients regarding medical science and clinical recommendations can lead to delayed therapy, resulting in complications during adulthood. We report a rare case of a large congenital ASD in a 20-year-old man. Echocardiography showed a 67-mm ostium secundum defect and moderate mitral and tricuspid regurgitation. The patient underwent transthoracic ASD repair along with mitral and tricuspid valvuloplasty. This report emphasizes the importance of educating patients about congenital malformations and potential interventions in developing countries, particularly in rural communities.
Collapse
Affiliation(s)
- Xia Xie
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mi Tang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Asher Kahn-Krell
- Department of Biomedical Engineering, School of Medicine, School of Engineering, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kele Qin
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jinfu Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chengming Fan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
5
|
Secundum atrial septal defects transcatheter closure versus surgery in adulthood: a 2000-2020 systematic review and meta-analysis of intrahospital outcomes. Cardiol Young 2021; 31:541-546. [PMID: 33827735 DOI: 10.1017/s1047951121001232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Technologically, advances in both transcatheter and surgical techniques have been continuing in the past 20 years, but an updated comprehensive comparison in device-based versus surgery in adults in terms of incidence of in-hospital mortality, perioperative stroke, and atrial fibrillation onset is still lacking. We investigate the performance of transcatheter device-based closure compared to surgical techniques by a systematic review and meta-analysis of the last 20 years literature data. MATERIAL AND METHODS The analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Literature search was performed based on Cochrane Library, Embase, PubMed, and Google Scholar to locate articles published between January 2000 and October 2020, regarding the comparison between short-term outcome and post-procedural complications of atrial septal defect patients receiving transcatheter or surgical closure. The primary outcome was the comparison of in-hospital mortality from all causes between patients treated with transcatheter closure or cardiac. Secondary outcomes were the onset of post-procedural atrial fibrillation or perioperative stroke. RESULTS A total of 2360 patients were included of which 1393 [mean age 47.6 years, 952 females (68.3%)] and 967 [mean age 40.3 years, 693 females (71.6%)] received a transcatheter device-based and surgery closure, respectively. In-hospital mortality [OR 0.16 (95% CI (0.66-0.44)), p = 0.0003, I2 = 0%], perioperative stroke [OR 0.51 (95% CI (0.31-0.84)), p = 0.003, I2 = 79%], and post-procedural atrial fibrillation [OR 0.14 (95% CI (0.03-0.61)), p = 0.009, I2 = 0%] significantly favoured transcatheter device-based closure. CONCLUSION Transcatheter atrial septal defect closure resulted safer in terms of in-hospital mortality, perioperative stroke, and post-procedural atrial fibrillation compared to traditional surgery.
Collapse
|
6
|
Tuan HX, Long PTP, Kien VD, Kramer H, Dalla-Pozza R. Cost comparison of transcatheter and operative closures for patients with secundum atrial septal defects in Vietnam. Heliyon 2021; 7:e05904. [PMID: 33490673 PMCID: PMC7809180 DOI: 10.1016/j.heliyon.2021.e05904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/09/2020] [Accepted: 01/04/2021] [Indexed: 11/26/2022] Open
Abstract
We aim to estimate and compare the costs of operative and transcatheter closure for patients with secundum atrial septal defect (ASD) in Vietnam. This was a retrospective cross-sectional study based on medical records of congenital heart diseases (CHD) patients in Da Nang Hospital, Vietnam from 2010 through 2015. All costs in this study were calculated according to a provider's perspective. All pricing data were converted into USD at the 2015 exchange rate. A total of 258 patients with secundum ASD were recruited in the study, including 35 patients treated by operative closure and 223 patients treated by transcatheter closure. The total treatment costs of the transcatheter closure group (US $3,107.9) were higher than those of the operative closure group (US $2,080.5). The cost of the procedure and medical supplies accounted for 67.3% of the total treatment cost in the operative closure group, while the cost of occlusion devices accounted for 62.2% of the total cost in the transcatheter closure group. Given the advantages of the transcatheter closure procedure, reducing occlusion device costs may increase the proportion of patients treated with this technique.
Collapse
Affiliation(s)
- Ho Xuan Tuan
- Center for International Health, Ludwig-Maximilians-University, Munich, Germany
- School of Medicine and Pharmacy, The Da Nang University, Da Nang city, Viet Nam
- Corresponding author.
| | - Phan The Phuoc Long
- School of Medicine and Pharmacy, The Da Nang University, Da Nang city, Viet Nam
| | - Vu Duy Kien
- OnCare Medical Technology Company Limited, Ha Noi, Viet Nam
| | - Harald Kramer
- Institute of Clinical Radiology, University Hospital of Munich, Germany
| | - Robert Dalla-Pozza
- Center for International Health, Ludwig-Maximilians-University, Munich, Germany
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Großhadern Clinic, Ludwig Maximilians University, Munich, Germany
| |
Collapse
|
7
|
Barry OM, Ali F, Ronderos M, Sudhaker A, Kumar RK, Mood MC, Corona-Villalobos C, Nguyen DT, Doherty-Schmeck K, Bergersen L, Gauvreau K, Jenkins KJ, Hasan BS. Pilot phase experience of the International Quality Improvement Collaborative catheterization registry. Catheter Cardiovasc Interv 2021; 97:127-134. [PMID: 32294315 DOI: 10.1002/ccd.28908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/23/2020] [Accepted: 03/31/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To describe the development of a quality collaborative for congenital cardiac catheterization centers in low and middle-income countries (LMICs) including pilot study data and a novel procedural efficacy measure. BACKGROUND Absence of congenital cardiac catheterization registries in LMICs led to the development of the International Quality Improvement Collaborative Congenital Heart Disease Catheterization Registry (IQIC-CHDCR). As a foundation for this initiative, the IQIC is a collaboration of pediatric cardiac surgical programs from LMICs. Participation in IQIC has been associated with improved patient outcomes. METHODS A web-based registry was designed through a collaborative process. A pilot study was conducted from October through December 2017 at seven existing IQIC sites. Demographic, hemodynamic, and adverse event data were obtained and a novel tool to assess procedural efficacy was applied to five specific procedures. Procedural efficacy was categorized using ideal, adequate, and inadequate. RESULTS A total of 429 cases were entered. Twenty-five adverse events were reported. The five procedures for which procedural efficacy was measured represented 48% of cases (n = 208) and 71% had complete data for analysis (n = 146). Procedure efficacy was ideal most frequently in patent ductus arteriosus (95%) and atrial septal defect (90%) device closure, and inadequate most frequently in coarctation procedures (100%), and aortic and pulmonary valvuloplasties (50%). CONCLUSIONS The IQIC-CHDCR has designed a feasible collaborative to capture catheterization data in LMICs. The novel tool for procedural efficacy will provide valuable means to identify areas for quality improvement. This pilot study and lessons learned culminated in the full launch of the IQIC-CHDCR.
Collapse
Affiliation(s)
- Oliver M Barry
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Fatima Ali
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | | | - Abish Sudhaker
- Amrita Institute for Medical Sciences and Research Centre, Kochi, Kerala, India
| | - R Krishna Kumar
- Amrita Institute for Medical Sciences and Research Centre, Kochi, Kerala, India
| | | | - Carlos Corona-Villalobos
- American British Cowdray Medical Center, I.A.P. and Instituto Nacional de Pediatria, Mexico City, Mexico
| | | | | | - Lisa Bergersen
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kathy J Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Babar S Hasan
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
8
|
Sivakumar K, Qureshi S, Pavithran S, Vaidyanathan S, Rajendran M. Simple Diagnostic Tools May Guide Transcatheter Closure of Superior Sinus Venosus Defects Without Advanced Imaging Techniques. Circ Cardiovasc Interv 2020; 13:e009833. [PMID: 33233933 DOI: 10.1161/circinterventions.120.009833] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a recent interest in nonsurgical correction of superior sinus venosus defects. Patient selection is currently based on advanced imaging and printing technologies. Simple clinical tools to select patients will expand its applicability in developing countries. METHODS Defects caudally extending toward the oval fossa and right upper pulmonary veins draining beyond the cavoatrial junction on transesophageal echocardiography were excluded. Balloon interrogation of cavoatrial junction confirmed complete occlusion of the defect with unobstructed pulmonary venous drainage to left atrium. Single long covered stents or overlapping covered stents were used to exclude sinus venosus defects. Closure of left-to-right interatrial shunt without causing pulmonary vein occlusion was confirmed on follow-up imaging. RESULTS Forty-four patients selected after transesophageal echocardiography underwent balloon interrogation with monitoring of right upper pulmonary vein. Eighteen out of 44 patients were ineligible. Twenty-four eligible patients with closure of left-to-right interatrial shunt without pulmonary vein occlusion underwent covered stent exclusion using single long stents in 15 and overlapping stents in the rest, while 2 patients are awaiting the procedure. Four patients aged 6 to 16 years received stents that were 18 mm or larger. Three patients had stent embolization that required surgical correction in 2 but in the last patient was managed nonsurgically with an overlapping covered stent with good final outcomes. Procedure was successful in 22 patients. At a median follow-up of 20 months (range, 3-54 months), there were no adverse events. Follow-up imaging showed trivial left-to-right shunt in 4 and unobstructed pulmonary veins in all patients. CONCLUSIONS Transesophageal echocardiography and balloon interrogation identified 60% of the patients with sinus venosus defects to be eligible for catheter closure. Overlapping stents are an alternative to custom-made long stents. Transesophageal echocardiography confirms procedural success on follow-up. Advanced imaging and printing technologies are not essential for successful outcomes and thus simple tests increase the feasibility in developing countries.
Collapse
Affiliation(s)
- Kothandam Sivakumar
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India (K.S., S.P., S.V., M.R.)
| | - Shakeel Qureshi
- Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, United Kingdom (S.Q.)
| | - Sreeja Pavithran
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India (K.S., S.P., S.V., M.R.)
| | - Sunitha Vaidyanathan
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India (K.S., S.P., S.V., M.R.)
| | - Monica Rajendran
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India (K.S., S.P., S.V., M.R.)
| |
Collapse
|
9
|
Farhaj Z, Hongxin L, Wenbin G, Zhang WL, Liang F, Zhang HZ, Yuan GD, Zou CW. Device closure of diverse layout of multi-hole secundum atrial septal defect: different techniques and long-term follow-up. J Cardiothorac Surg 2019; 14:130. [PMID: 31272459 PMCID: PMC6610982 DOI: 10.1186/s13019-019-0952-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background There are no unanimous reports on different layouts and classifications of multi-hole secundum atrial septal defects (MHASD) and subsequent standardized occlusion techniques. The MHASD can be isolated or cribriform with variable inter-defects distance. In this retrospective study, experience-based classification and two approaches-based occlusion results are presented. Methods We retrospectively collected and analyzed data of 150 MHASD patients from 1320 patients who underwent atrial septal defect occlusion in our institute. The MHASD patients were categorized into 4 types; type A, B, C and D and occluded under exclusive transesophageal echocardiographic guidance. According to different types, 122 patients were occluded using peratrial approach and 28 patients via percutaneous approach. In type A, single device implantation is performed to occlude the large hole and squeeze the small one. For type B single or double-device deployment was performed depending on an inter-defects distance. In type C and D, a patent foramen-ovale (PF) device was selectively positioned to the central defect to occlude the central defect and cover the peripheral ones. In peratrial approach, 8 patients underwent inter-defects septal puncture technique to achieve single-device occlusion. The intracardiac manipulation time, procedural time, double device deployment, redeployment rate, residual shunt, and proportions were analyzed between (and within peratrial technique) two techniques. Results Successful occlusion was achieved in all 150 patients. Single device occlusion was applied in 78/84 type A and 22/37 type B patients (p < 0.05). Double device occlusion was more applicable to type B than A patients (p < 0.01). Sixteen of 21 type C and all type D patients used PF device for a satisfactory occlusion. Redeployment of the device occurred frequently in type B patients than A (p < 0.01). The intracardiac manipulation time and procedural time were shorter in type A than B (p < 0.05). The intracardiac manipulation time was also shortened in type A peratrial than type A percutaneous group (p < 0.05). Complete occlusion rate for all patients at discharge was 70% and rose to 82% at 1 year follow up. Conclusions The diverse layouts and classification of MHASDs can help to choose different techniques and proper devices of different kinds to achieve better occlusion results.
Collapse
Affiliation(s)
- Zeeshan Farhaj
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No 324 Jingwu Road, Jinan, 250021, China
| | - Li Hongxin
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No 324 Jingwu Road, Jinan, 250021, China.
| | - Guo Wenbin
- Ultrasound Department, Shandong Provincial Hospital Affiliated to Shandong University, No 324 Jingwu Road, Jinan, 250021, China
| | - Wen-Long Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No 324 Jingwu Road, Jinan, 250021, China
| | - Fei Liang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No 324 Jingwu Road, Jinan, 250021, China
| | - Hai-Zhou Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No 324 Jingwu Road, Jinan, 250021, China
| | - Gui-Dao Yuan
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No 324 Jingwu Road, Jinan, 250021, China
| | - Cheng-Wei Zou
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No 324 Jingwu Road, Jinan, 250021, China
| |
Collapse
|
10
|
Mojadidi MK, Mahmoud AN, Mahtta D, Zaman MO, Elgendy IY, Elgendy AY, Agarwal N, Patel NK, Gertz ZM, Wayangankar SA, Lew DC, Jneid H, Don CW, Meier B, Tobis JM. Incidence and Causes of 30-day Readmissions after Surgical Versus Percutaneous Secundum Atrial Septal Defect Closure: A United States Nationwide Analysis. STRUCTURAL HEART 2019. [DOI: 10.1080/24748706.2018.1559963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Mohammad K. Mojadidi
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ahmed N. Mahmoud
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Dhruv Mahtta
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Muhammad O. Zaman
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Islam Y. Elgendy
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Akram Y. Elgendy
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Nayan Agarwal
- Interventional Cardiology, Cardiovascular Institute of the South, Houma, Louisiana, USA
| | - Nimesh K. Patel
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Zachary M. Gertz
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Siddharth A. Wayangankar
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - David C. Lew
- Florida Heart and Vascular Center, Leesburg, Florida, USA
| | - Hani Jneid
- Division of Cardiology and Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Creighton W. Don
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Bernhard Meier
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Jonathan M. Tobis
- Program in Interventional Cardiology, Division of Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| |
Collapse
|
11
|
Vida VL, Zanotto L, Zanotto L, Tessari C, Padalino MA, Zanella F, Pittarello D, Stellin G. Minimally invasive surgery for atrial septal defects: a 20-year experience at a single centre. Interact Cardiovasc Thorac Surg 2019; 28:961-967. [DOI: 10.1093/icvts/ivz017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 12/21/2018] [Accepted: 12/27/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vladimiro L Vida
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Lorenza Zanotto
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Lucia Zanotto
- Department of Statistical Sciences, University of Padua, Padua, Italy
| | - Chiara Tessari
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Massimo A Padalino
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Fabio Zanella
- Cardiac Perfusion Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera of Padua, University of Padua, Padua, Italy
| | - Demetrio Pittarello
- Cardiac Anesthesia Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Giovanni Stellin
- Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| |
Collapse
|
12
|
Argent AC. Considerations for Assessing the Appropriateness of High-Cost Pediatric Care in Low-Income Regions. Front Pediatr 2018; 6:68. [PMID: 29637061 PMCID: PMC5880905 DOI: 10.3389/fped.2018.00068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/08/2018] [Indexed: 12/24/2022] Open
Abstract
It may be difficult to predict the consequences of provision of high-cost pediatric care (HCC) in low- and middle-income countries (LMICs), and these consequences may be different to those experienced in high-income countries. An evaluation of the implications of HCC in LMICs must incorporate considerations of the specific context in that country (population age profile, profile of disease, resources available), likely costs of the HCC, likely benefits that can be gained versus the costs that will be incurred. Ideally, the process that is followed in decision making around HCC should be transparent and should involve the communities that will be most affected by those decisions. It is essential that the impacts of provision of HCC are carefully monitored so that informed decisions can be made about future provision medical interventions.
Collapse
Affiliation(s)
- Andrew C Argent
- Paediatric Critical Care, Paediatrics and Child Health, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| |
Collapse
|
13
|
Abstract
The purpose of this review is to discuss the management of atrial septal defects (ASD), paying particular attention to the most recent developments. There are four types of ASDs: ostium secundum, ostium primum, sinus venosus, and coronary sinus defects. The fifth type, patent foramen ovale-which is present in 25 to 30% of normal individuals and considered a normal variant, although it may be the seat of paradoxical embolism, particularly in adults-is not addressed in this review. The indication for closure of the ASDs, by and large, is the presence of right ventricular volume overload. In asymptomatic patients, the closure is usually performed at four to five years of age. While there was some earlier controversy regarding ASD closure in adult patients, currently it is recommended that the ASD be closed at the time of presentation. Each of the four defects is briefly described followed by presentation of management, whether by surgical or percutaneous approach, as the case may be. Of the four types of ASDs, only the ostium secundum defect is amenable to percutaneous occlusion. For ostium secundum defects, transcatheter closure has been shown to be as effective as surgical closure but with the added benefits of decreased hospital stay, avoidance of a sternotomy, lower cost, and more rapid recovery. There are several FDA-approved devices in use today for percutaneous closure, including the Amplatzer® Septal Occluder (ASO), Amplatzer® Cribriform device, and Gore HELEX® device. The ASO is most commonly used for ostium secundum ASDs, the Gore HELEX® is useful for small to medium-sized defects, and the cribriform device is utilized for fenestrated ASDs. The remaining types of ASDs usually require surgical correction. All of the available treatment modes are safe and effective and prevent the development of further cardiac complications.
Collapse
Affiliation(s)
- P Syamasundar Rao
- University of Texas-Houston McGovern Medical School, Children Memorial Hermann Hospital, Houston, USA
| | - Andrea D Harris
- University of Texas-Houston McGovern Medical School, Children Memorial Hermann Hospital, Houston, USA
| |
Collapse
|
14
|
Villablanca PA, Briston DA, Rodés-Cabau J, Briceno DF, Rao G, Aljoudi M, Shah AM, Mohananey D, Gupta T, Makkiya M, Ramakrishna H, Garcia MJ, Pass RH, Peek G, Zaidi AN. Treatment options for the closure of secundum atrial septal defects: A systematic review and meta-analysis. Int J Cardiol 2017; 241:149-155. [DOI: 10.1016/j.ijcard.2017.03.073] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
|
15
|
Chen Q, Cao H, Chen ZY, Zhang GC, Chen LW, Xu F, He JJ. Comparative study of the transcatheter and transthoracic device closure treatments for atrial septal defect: A Chinese single-institution experience. Medicine (Baltimore) 2017; 96:e6316. [PMID: 28296745 PMCID: PMC5369900 DOI: 10.1097/md.0000000000006316] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/26/2017] [Accepted: 02/14/2017] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to compare patient populations, safety, feasibility, complications, and total costs of the transcatheter and transthoracic device closure treatments for secundum atrial septal defect.From January 2014 to December 2014, we enrolled 155 patients with secundum atrial septal defects in our hospital. The patients were divided into 2 groups: the 70 patients in group A underwent transcatheter device closure, and the 85 patients in group B underwent transthoracic intraoperative device closure with a right lateral mini-thoracotomy.In group A, the total occlusion rate was 94.3% immediately after the operation, 100% at 3 months, and 100% at 12 months of follow-up; the group A results were not statistically different from the group B results (94.1%, 98.8%, 98.8%, respectively). There was a statistically significant difference in the minor complication rate (P < 0.05), and there were no reported deaths. There was a greater indicated scope using the transthoracic closure device to treat atrial septal defects. In our comparative study, the patients in group B had longer intensive care unit stays and hospital stays than group A (P < 0.05).Both of the device closure treatment options for secundum atrial septal defect are safe and feasible. The transcatheter device closure approach has the advantages of more cosmetic results, less trauma, and a shorter hospital stay than the transthoracic approach. On the contrary, the transthoracic closure device is an economical alternative choice, particularly for patients who are not eligible for the transcatheter closure device.
Collapse
Affiliation(s)
| | - Hua Cao
- Department of Cardiovascular Surgery
| | - Zhao-yang Chen
- Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, P. R. China
| | | | | | - Fan Xu
- Department of Cardiovascular Surgery
| | | |
Collapse
|
16
|
Saxton AT, Poenaru D, Ozgediz D, Ameh EA, Farmer D, Smith ER, Rice HE. Economic Analysis of Children's Surgical Care in Low- and Middle-Income Countries: A Systematic Review and Analysis. PLoS One 2016; 11:e0165480. [PMID: 27792792 PMCID: PMC5085034 DOI: 10.1371/journal.pone.0165480] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/12/2016] [Indexed: 12/05/2022] Open
Abstract
Background Understanding the economic value of health interventions is essential for policy makers to make informed resource allocation decisions. The objective of this systematic review was to summarize available information on the economic impact of children’s surgical care in low- and middle-income countries (LMICs). Methods We searched MEDLINE (Pubmed), Embase, and Web of Science for relevant articles published between Jan. 1996 and Jan. 2015. We summarized reported cost information for individual interventions by country, including all costs, disability weights, health outcome measurements (most commonly disability-adjusted life years [DALYs] averted) and cost-effectiveness ratios (CERs). We calculated median CER as well as societal economic benefits (using a human capital approach) by procedure group across all studies. The methodological quality of each article was assessed using the Drummond checklist and the overall quality of evidence was summarized using a scale adapted from the Agency for Healthcare Research and Quality. Findings We identified 86 articles that met inclusion criteria, spanning 36 groups of surgical interventions. The procedure group with the lowest median CER was inguinal hernia repair ($15/DALY). The procedure group with the highest median societal economic benefit was neurosurgical procedures ($58,977). We found a wide range of study quality, with only 35% of studies having a Drummond score ≥ 7. Interpretation Our findings show that many areas of children’s surgical care are extremely cost-effective in LMICs, provide substantial societal benefits, and are an appropriate target for enhanced investment. Several areas, including inguinal hernia repair, trichiasis surgery, cleft lip and palate repair, circumcision, congenital heart surgery and orthopedic procedures, should be considered “Essential Pediatric Surgical Procedures” as they offer considerable economic value. However, there are major gaps in existing research quality and methodology which limit our current understanding of the economic value of surgical care.
Collapse
Affiliation(s)
- Anthony T. Saxton
- Duke Global Health Institute and Duke University Medical Center, Durham, NC, United States of America
| | - Dan Poenaru
- McMaster Paediatric Surgery Research Collaborative, Dept. of Surgery, McMaster University, Hamilton, Canada
| | - Doruk Ozgediz
- Yale-New Haven Hospital, New Haven, CT, United States of America
| | | | - Diana Farmer
- University of California-Davis Health System, Davis, CA, United States of America
| | - Emily R. Smith
- Duke Global Health Institute and Duke University Medical Center, Durham, NC, United States of America
| | - Henry E. Rice
- Duke Global Health Institute and Duke University Medical Center, Durham, NC, United States of America
- * E-mail:
| |
Collapse
|
17
|
Sun Y, Zhu P, Zhou P, Guo Y, Zheng SY. Intra-operative device closure of perimembranous ventricular septal defect without cardiopulmonary bypass under guidance of trans-epicardial echocardiography: a single center experience. J Cardiothorac Surg 2016; 11:87. [PMID: 27229932 PMCID: PMC4882798 DOI: 10.1186/s13019-016-0483-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 05/17/2016] [Indexed: 11/30/2022] Open
Abstract
Background Intraoperative device closure of perimembranous ventricular septal defect(VSD) through a lower mini-sternotomy is safe, less invasive, and has excellent surgical and cosmetic outcomes. Our study is to evaluate the feasibility of closing VSD under guidance of trans-epicardial echocardiography. Methods We reviewed the clinical course of 41 patients referred to our institution for minimally invasive closure of perimembranous VSD. The trans-epicardial echocardiography(TEE) was used to monitor the whole procedure to guide the positioning of device and evaluate the operative effect instantly after operation. Result The procedure was successfully done in 38 patients(92.6 %) with mean age of 1.2 ± 1.5 years(range 0.5-6.1 years),mean weight of 10.78 ± 6.87 kg(range 5.2 ~ 26 kg) and VSD size of 5.1 ± 1.13 mm(range 5 ~ 10 mm). Three cases failed, including two cases whose guide-wires could not pass through VSDs and one case whose occluder could not repair VSD well. Three patients had tiny residual shunts because of the shifting of occluders. There were no major complications such as arrhythmia, valve regurgitation and the failure of occluder during follow-up(Mean 2.3 ± 1.2 years). TEE provided superior imaging of shapes and surrounding structures of the VSDs, and guide-wires passing through VSDs. Conclusions Intraoperative device closure of perimembranous VSD through a lower mini-sternotomy without cardiopulmonary bypass appears to be a safe and effective procedure. The use of trans-epicardial echocardiography provides useful information for intraoperative device closure of VSD.
Collapse
Affiliation(s)
- Yong Sun
- Department of Cardiovascular Surgery, NanFang Hospital, Southern Medical University, GuangZhou, GuangDong, People's Republic of China
| | - Peng Zhu
- Department of Cardiovascular Surgery, NanFang Hospital, Southern Medical University, GuangZhou, GuangDong, People's Republic of China
| | - Pengyu Zhou
- Department of Cardiovascular Surgery, NanFang Hospital, Southern Medical University, GuangZhou, GuangDong, People's Republic of China
| | - Yilong Guo
- Department of Cardiovascular Surgery, NanFang Hospital, Southern Medical University, GuangZhou, GuangDong, People's Republic of China
| | - Shao-Yi Zheng
- Department of Cardiovascular Surgery, NanFang Hospital, Southern Medical University, GuangZhou, GuangDong, People's Republic of China.
| |
Collapse
|
18
|
Transfemoral Device Occlusion and Minimally Invasive Surgical Repair for Doubly Committed Subarterial Ventricular Septal Defects. Pediatr Cardiol 2015; 36:1624-9. [PMID: 26033347 DOI: 10.1007/s00246-015-1207-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
Transfemoral device occlusion and minimally invasive surgical repair are performed for doubly committed subarterial ventricular septal defect (dcVSD) to reduce the invasiveness of the conventional surgical repair through a median sternotomy. However, few studies have compared them in terms of effectiveness and cost. Inpatients with isolated dcVSD who had undergone transfemoral device occlusion or minimally invasive surgical repair from January 2011 to June 2014 were reviewed for a comparative investigation between the two procedures. Procedure success was achieved in 36 transfemoral (75 %) and in 36 surgical (100 %) procedures (p = 0.001). Transfemoral patients were older, with a VSD size similar to that of surgical patients (14.5 ± 11.7 vs 4.4 ± 2.9 years, p < 0.001; 4.5 ± 1.5 vs 4.4 ± 1.3 mm, p = 0.577, respectively). No significant difference was observed in complication rates between the two treatment groups (p = 1). No large residual shunt was observed. Small residual shunt was noted in two transfemoral patients and four surgical patients (p = 0.674). All these small residual shunts closed spontaneously during follow-up. The surgical repair costs 26 % less than the device occlusion (Yuan 22063.2 ± 343.9 vs Yuan 29970.1 ± 1335.2, p < 0.001), where most of the cost was attributed to the occluder in the amount of Yuan 19,500. Compared with device occlusion, minimally invasive surgical repair can provide superior efficacy and comparable complication rates. In addition, it is 26 % cheaper than device occlusion. In low-income countries where healthcare resources are limited, medical resources must be judiciously allocated to the treatment that allows for effective treatment of the largest number of patients.
Collapse
|
19
|
Senna KMSE, Sarti FM, Costa MGSD, Nita ME, Santos MDS, Tura BR, Correia MG. Budget impact analysis of the percutaneous septal occluder for treatment of ostium secundum atrial septal defects in the Brazilian Unified National Health System. CAD SAUDE PUBLICA 2015; 31:1756-64. [PMID: 26375653 DOI: 10.1590/0102-311x00039014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to perform a budget impact analysis on the adoption of percutaneous occlusion of ostium secundum atrial septal defects in the Brazilian Unified National Health System. Costs were collected using micro-costing technique from medical records for each treatment technique (conventional surgery versus percutaneous septal occluder) at a public federal hospital specialized in high-complexity cardiology. The analysis showed that expenditures associated with percutaneous occlusion were lower than with conventional surgery, and sensitivity analysis confirmed the cost reduction in several scenarios, showing a significant budget impact with a 30% adoption rate for the percutaneous occluder (savings of approximately 1.5 million dollars per year). The study indicates that the adoption of the percutaneous septal occluder would mean cost savings of approximately 3.5 million dollars for the Brazilian public health system.
Collapse
|
20
|
Castaldi B, Vida VL, Argiolas A, Maschietto N, Cerutti A, Gregori D, Stellin G, Milanesi O. Late Electrical and Mechanical Remodeling After Atrial Septal Defect Closure in Children: Surgical Versus Percutaneous Approach. Ann Thorac Surg 2015; 100:181-6. [DOI: 10.1016/j.athoracsur.2015.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 03/03/2015] [Accepted: 03/10/2015] [Indexed: 11/17/2022]
|
21
|
Siddiqui WT, Usman T, Atiq M, Amanullah MM. Transcatheter versus surgical closure of atrial septum defect: a debate from a developing country. J Cardiovasc Thorac Res 2014; 6:205-10. [PMID: 25610550 PMCID: PMC4291597 DOI: 10.15171/jcvtr.2014.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/11/2014] [Indexed: 11/12/2022] Open
Abstract
Introduction: This study compares the effectiveness and cost of trans-catheter verses surgical closure of secundum atrial septum defect (ASD). ASD accounts for 10% of congenital cardiac defects. Trans-catheter closure of secundum ASD is increasingly used as the primary intervention. Surgical repair is advised in a proportion of secundum type defects which are unsuitable for device closure.
Methods: We reviewed the clinical course of 176 patients who underwent closure of isolated secundum ASD. The patients were assigned to either the device or surgical group depending upon the treatment they received. Successful closure was assessed immediately after the procedure. The following outcomes were studied: mortality, morbidity, hospital stay, and costs.
Results: Ninety five patients were in the surgical group and 81 patients were in the group undergoing device closure. The median age was 14.0 years (range 1.1-61.0) for surgical group and 24.0 years (range 0.5-68.0) for the device group. The mortality in both groups was 0. The procedure success rate was 100% for the surgical group and 96.3% for the device group. The complication rate was 13.7% for surgical group and 7.4% for the device group. The mean length of hospital stay was 5.0 ± 2.7 days for surgical group and 3.0 ± 0.4 days for device group. The procedure cost for surgery was found to be 12.3% lower than that of trans-catheter closure.
Conclusion: Successful closure is achieved by both methods. Trans-catheter closure results in lower rate of complication and hospital stay but the cost of the procedure tends to be higher than surgery.
Collapse
Affiliation(s)
| | - Tariq Usman
- Department of Cardiothoracic Surgery, The Aga Khan University Hospital (AKUH), Karachi, Pakistan
| | - Mehnaz Atiq
- Department of Pediatrics, The Aga Khan University Hospital (AKUH), Karachi, Pakistan
| | | |
Collapse
|
22
|
Cost-effectiveness of procedures for treatment of ostium secundum atrial septal defects occlusion comparing conventional surgery and septal percutaneous implant. PLoS One 2014; 9:e108966. [PMID: 25302806 PMCID: PMC4193888 DOI: 10.1371/journal.pone.0108966] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 09/05/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The study performs a cost-effectiveness analysis of procedures for atrial septal defects occlusion, comparing conventional surgery to septal percutaneous implant. METHODS A model of analytical decision was structured with symmetric branches to estimate cost-effectiveness ratio between the procedures. The decision tree model was based on evidences gathered through meta-analysis of literature, and validated by a panel of specialists. The lower number of surgical procedures performed for atrial septal defects occlusion at each branch was considered as the effectiveness outcome. Direct medical costs and probabilities for each event were inserted in the model using data available from Brazilian public sector database system and information extracted from the literature review, using micro-costing technique. Sensitivity analysis included price variations of percutaneous implant. RESULTS The results obtained from the decision model demonstrated that the percutaneous implant was more cost effective in cost-effectiveness analysis at a cost of US$8,936.34 with a reduction in the probability of surgery occurrence in 93% of the cases. Probability of atrial septal communication occlusion and cost of the implant are the determinant factors of cost-effectiveness ratio. CONCLUSIONS The proposal of a decision model seeks to fill a void in the academic literature. The decision model proposed includes the outcomes that present major impact in relation to the overall costs of the procedure. The atrial septal defects occlusion using percutaneous implant reduces the physical and psychological distress to the patients in relation to the conventional surgery, which represent intangible costs in the context of economic evaluation.
Collapse
|
23
|
Costa R, Pedra CAC, Ribeiro M, Pedra S, Ferreira-Da-Silva AL, Polanczyk C, Berwanger O, Biasi A, Ribeiro R. Incremental cost–effectiveness of percutaneous versus surgical closure of atrial septal defects in children under a public health system perspective in Brazil. Expert Rev Cardiovasc Ther 2014; 12:1369-78. [DOI: 10.1586/14779072.2014.967216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
24
|
Yalcinkaya E, Celik M, Bugan B. Determining an optimal technique for atrial septal defect closure: percutaneous closure as a therapeutic modality of choice. Ann Thorac Med 2014; 9:128. [PMID: 24791179 PMCID: PMC4005161 DOI: 10.4103/1817-1737.128865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Emre Yalcinkaya
- Department of Cardiology, Aksaz Military Hospital, 48750, Mugla, Turkey
| | - Murat Celik
- Department of Cardiology, Gulhane Military Medical Faculty, 06018, Ankara, Turkey
| | - Baris Bugan
- Department of Cardiology, Malatya Military Hospital, Malatya, Turkey E-mail:
| |
Collapse
|
25
|
Milev I, Idrizi S, Zimbakov Z, Ampova-Sokolov V, Zafirovska P, Nikolov S, Angjuseva T, Mitrev Z. Percutaneous Interventional Treatment of Atrial Septal Defect Secundum in Macedonia. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Atrial septal defect (ASD) is a common congenital heart disorder (CHD). While conventional open surgical treatment is the standard procedure in our country, percutaneous device closure with implantation of an atrial septal defect occluder is a promising alternative with very few peri and post procedural complications.Aim: The aim of the study was to present the rate of success and complications in percutaneous ASD closure with the implantation of an atrial septal defect occluder.Material and Methods: We treated 153 patients (ages 2-76; 65% female) with ASD secundum with percutaneous trans catheter closure using a septal occluder. Follow up was on a 3 month interval and assessment included clinical, electrophysiological and echocardiographic status. Results: The mean diameter of ASD obtained via balloon sizing was 16 ± 16 mm. Multiple ASDs were found in 20 (13%) patients and deficitary aortic and anterior rim (< 5 mm) was present in 16 (10%) patients. Due to inadequate placement and/or sizing, the device was removed and replaced in seven patients (5%). During follow up, trivial shunt was present in 4 (2.6%) patients. The diameter of the right ventricle corrected for age was reduced by an average of 20% by the first month and in 130 (86%) of patients it had normalized by one year of follow up. During follow up, 16 (10%) patients reported transient headaches and 3 (1.9%) patients had transient atrial fibrillation (AF).Conclusion: In conclusion, the implantation of a septal occluder was found to be a safe procedure that resulted in improved hemodynamic parameters that result from right ventricular volume overload with favorable short- and mid-term results.
Collapse
|
26
|
Mylotte D, Quenneville SP, Kotowycz MA, Xie X, Brophy JM, Ionescu-Ittu R, Martucci G, Pilote L, Therrien J, Marelli AJ. Long-term cost-effectiveness of transcatheter versus surgical closure of secundum atrial septal defect in adults. Int J Cardiol 2014; 172:109-14. [DOI: 10.1016/j.ijcard.2013.12.144] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 12/02/2013] [Accepted: 12/26/2013] [Indexed: 11/29/2022]
|
27
|
Rigatelli G, Cardaioli P, Hijazi ZM. Contemporary clinical management of atrial septal defects in the adult. Expert Rev Cardiovasc Ther 2014; 5:1135-46. [DOI: 10.1586/14779072.5.6.1135] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
28
|
Abaci A, Unlu S, Alsancak Y, Kaya U, Sezenoz B. Short and long term complications of device closure of atrial septal defect and patent foramen ovale: Meta-analysis of 28,142 patients from 203 studies. Catheter Cardiovasc Interv 2013; 82:1123-38. [DOI: 10.1002/ccd.24875] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/27/2013] [Accepted: 02/09/2013] [Indexed: 01/15/2023]
Affiliation(s)
- Adnan Abaci
- Department of Cardiology; School of Medicine; Gazi University; Ankara Turkey
| | - Serkan Unlu
- Department of Cardiology; School of Medicine; Gazi University; Ankara Turkey
| | - Yakup Alsancak
- Department of Cardiology; School of Medicine; Gazi University; Ankara Turkey
| | - Ulker Kaya
- Department of Cardiology; School of Medicine; Gazi University; Ankara Turkey
| | - Burak Sezenoz
- Department of Cardiology; School of Medicine; Gazi University; Ankara Turkey
| |
Collapse
|
29
|
Monfredi O, Luckie M, Mirjafari H, Willard T, Buckley H, Griffiths L, Clarke B, Mahadevan VS. Percutaneous device closure of atrial septal defect results in very early and sustained changes of right and left heart function. Int J Cardiol 2013; 167:1578-84. [PMID: 22608895 DOI: 10.1016/j.ijcard.2012.04.081] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 04/14/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Oliver Monfredi
- Cardiovascular Research Group, School of Biomedicine, The University of Manchester, Level 3 Core Technology Facility, Grafton Street, Manchester M13 9NT, United Kingdom.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Yao DK, Chen H, Ma LL, Ma ZS, Wang LX. Totally Endoscopic Atrial Septal Repair with or without Robotic Assistance: A Systematic Review and Meta-analysis of Case Series. Heart Lung Circ 2013; 22:433-40. [DOI: 10.1016/j.hlc.2012.12.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 12/25/2012] [Accepted: 12/28/2012] [Indexed: 02/07/2023]
|
31
|
Li QZ, Cao H, Chen Q, Zhang GC, Chen LW, Chen DZ. Balloon valvuloplasty through the right ventricle: another treatment of pulmonary atresia with intact ventricular septum. Ann Thorac Surg 2013; 95:1670-4. [PMID: 23506634 DOI: 10.1016/j.athoracsur.2013.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 01/29/2013] [Accepted: 02/04/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND This was a study to evaluate the safety and feasibility of balloon valvuloplasty of the pulmonary valve through the right ventricle (RV) for the treatment of pulmonary atresia with intact ventricular septum (PA-IVS). METHODS Ten neonates with PA-IVS, who underwent balloon valvuloplasty of the pulmonary valve through the RV at our institution from January 2008 to May 2010, were enrolled in this study. The oxygen saturation range was 60% to 83% (median 76%). The Z-value range of the tricuspid valve annulus was -2 to 2 (median 0.15), the diameter range of the pulmonary valve annulus was 4.6 to 8.6 mm (median 7.3), and the RV systolic pressure range was 88 to 124 mm Hg (median 106.5). A guidewire was used to perforate the pulmonary valve through the RV, followed by balloon dilation of the valve. The procedure was guided by transesophageal echocardiography. RESULTS The procedure was carried out successfully in all patients. The procedure time ranged from 64 to 110 minutes (median 82.5). Mechanical ventilation time ranged from 8 to 36 hours (median 11), and hospital stay ranged from 7 to 13 days (median 9). After the procedure, the median oxygen saturation increased to 89.5%, the median RV systolic pressure decreased to 45 mm Hg, and the gradient across the pulmonary valve ranged from 20 to 45 mm Hg (median 27.5). Minor complications included transient supraventricular tachycardia (n = 1), blood loss requiring transfusion (n = 2), moderate pulmonary regurgitation (n = 1), and mild pulmonary regurgitation (n = 3). There were no cases of cardiac perforation, main pulmonary artery aneurysm, or low output syndrome. Follow-up of patients ranged from 8 to 15 months (median 12.3). All patients remained clinically well. CONCLUSIONS Balloon valvuloplasty of the pulmonary valve through the RV is a safe and feasible alternative to surgical valvotomy or percutaneous balloon dilation. Early results are encouraging.
Collapse
Affiliation(s)
- Qian-Zhen Li
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | | | | | | | | | | |
Collapse
|
32
|
Wiegand G, Binder W, Ulmer H, Kaulitz R, Riethmueller J, Hofbeck M. Noninvasive cardiac output measurement at rest and during exercise in pediatric patients after interventional or surgical atrial septal defect closure. Pediatr Cardiol 2012; 33:1109-14. [PMID: 22354224 DOI: 10.1007/s00246-012-0239-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 11/09/2011] [Indexed: 10/28/2022]
Abstract
In the majority of patients, secundum atrial septal defects (ASDs) are treated interventionally or surgically, before the onset of clinical symptoms, between 3 and 6 years of age. Because right-ventricular dimensions usually normalize after ASD closure, it has been assumed that cardiac function and exercise performance also normalize at long-term follow-up. The aim of our study was to determine cardiac index (CI) at rest and during exercise at medium-term follow-up of children who had undergone surgical or interventional closure of ASD because no such reports have been published thus far. Seventeen patients (age range 8.8-17.3 years) who underwent surgical correction were included together with 17 subjects who received an interventional procedure with Amplatzer and Helex occluders (age range 12.2-17.3 years). The study was performed after a median interval of 8.6 years (range 6.5-11.6) after the procedure. Twelve healthy children of comparable age served as controls. CI measurements were performed based on the inert gas-rebreathing method with the Innocor system. For exercise testing, the standard treadmill protocol of the German Society of Pediatric Cardiology was used. CI, stroke volume (SV), and heart rate (HR) were determined at rest and at two standardized submaximal exercise levels (levels 3 and 6). CI increased in all subjects under exercise conditions. Neither SV nor HR displayed significant differences between the three groups either at rest or under exercise conditions. Although HR increased continuously, no increase of indexed SV occurred beyond level 3. Noninvasive determination of CI at rest and during exercise with the IGR method is feasible in the pediatric age group. At medium-term follow-up, we found no significant differences between patients who underwent surgical or interventional ASD closure compared with normal controls.
Collapse
Affiliation(s)
- Gesa Wiegand
- Department of Pediatric Cardiology, University Children's Hospital, Hoppe-Seyler-Strasse 1, Tuebingen, Germany.
| | | | | | | | | | | |
Collapse
|
33
|
RIGATELLI GIANLUCA, DELL'AVVOCATA FABIO, CARDAIOLI PAOLO, GIORDAN MASSIMO, DUNG HOTHUONG, NGHIA NGUYENTHUONG, DAGGUBATI RAMESH, NANJIUNDAPPA ARAVINDA. Safety and Long-Term Outcome of Modified Intracardiac Echocardiography-Assisted “No-Balloon” Sizing Technique for Transcatheter Closure of Ostium Secundum Atrial Septal Defect. J Interv Cardiol 2012; 25:628-34. [DOI: 10.1111/j.1540-8183.2012.00755.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
34
|
GRUNER CHRISTIANE, AKKAYA ERSAN, KRETSCHMAR OLIVER, ROFFI MARCO, CORTI ROBERTO, JENNI ROLF, EBERLI FRANZR. Pharmacologic Preconditioning Therapy Prior to Atrial Septal Defect Closure in Patients at High Risk for Acute Pulmonary Edema. J Interv Cardiol 2012; 25:505-12. [DOI: 10.1111/j.1540-8183.2012.00747.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
|
35
|
Safety and feasibility of intra-operative device closure of atrial septal defect with transthoracic minimal invasion. Eur J Cardiothorac Surg 2012; 41:121-5. [PMID: 21592809 DOI: 10.1016/j.ejcts.2011.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The study aims to evaluate the safety and feasibility of intra-operative device closure of atrial septal defect with transthoracic minimal invasion. METHODS From May 2006 to June 2009, 252 patients with secundum-type atrial septal defect closure were enrolled in our institution. The patients were divided into two groups, with 182 patients in group I with intra-operative device closure and 72 in group II with surgical closure. In group I, the patients' age ranged from 3 months to 62 years (mean±standard deviation, 19.0±16.7 years). This approach involved a transthoracic minimal invasion that was performed after full evaluation of the atrial septal defect by transthoracic echocardiography, deploying the device through the delivery sheath to occlude the atrial septal defect. RESULTS In group I, 180 patients were occluded successfully under this approach. The size of the occluder device implanted ranged from 6 to 48 mm. Minor complications occurred, which included transient arrhythmias (n=23) and pleural effusion (n=15). Two patients with postoperative cardiac arrest were successfully cardiopulmonary resuscitated. Another two patients with occluder dislodged back into the right atrium were turned to surgical repair with cardiopulmonary bypass on the postoperative day. In group II, all patients were occluded successfully, and almost all patients needed blood transfusion and suffered from various minor complications. All discharged patients were followed up for 1-5 years. During this period, we found no recurrence, no thrombosis, even no device failure. In our comparative studies, group II had significantly longer intensive care unit (ICU) stay and hospital stay than group I (p<0.05). The cost for group I was less than group II (p<0.05). CONCLUSIONS Intra-operative device closure of atrial septal defect with transthoracic minimal invasion is a safe and feasible technique. It had the advantages of cost savings, yielding better cosmetic results, and leaving less trauma than surgical closure.
Collapse
|
36
|
Roy D, Sharma R, Bunce N, Ward D, Brecker SJ. Selecting the optimal closure device in patients with atrial septal defects and patent foramen ovale. Interv Cardiol 2012. [DOI: 10.2217/ica.11.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
37
|
Rigatelli G, Dell' Avvocata F, Cardaioli P, Giordan M, Vassiliev D, Nghia NT, Chen JP. Five-year Follow-up of Intracardiac Echocardiography-assisted Transcatheter Closure of Complex Ostium Secundum Atrial Septal Defect. CONGENIT HEART DIS 2011; 7:103-10. [DOI: 10.1111/j.1747-0803.2011.00567.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
38
|
Butera G, Biondi-Zoccai G, Sangiorgi G, Abella R, Giamberti A, Bussadori C, Sheiban I, Saliba Z, Santoro T, Pelissero G, Carminati M, Frigiola A. Percutaneous versus surgical closure of secundum atrial septal defects: a systematic review and meta-analysis of currently available clinical evidence. EUROINTERVENTION 2011; 7:377-85. [PMID: 21729841 DOI: 10.4244/eijv7i3a63] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Gianfranco Butera
- Pediatric Cardiology, Guch Unit and Cardiac Surgery, Policlinico San Donato I.R.C.C.S., Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Intraoperative device closure of atrial septal defects with inferior vena cava rim deficiency: A safe alternative to surgical repair. J Thorac Cardiovasc Surg 2011; 141:631-6. [DOI: 10.1016/j.jtcvs.2010.07.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Revised: 06/14/2010] [Accepted: 07/31/2010] [Indexed: 11/21/2022]
|
40
|
Wei X, Yi W, Xu X, Zhang J, Li J, Yu S, Yi D. Transthoracic occlusion for secundum atrial septal defects unsuitable for transcatheter occlusion approach. J Thorac Cardiovasc Surg 2011; 142:113-9. [PMID: 21247592 DOI: 10.1016/j.jtcvs.2010.10.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 08/11/2010] [Accepted: 10/16/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Transcatheter occlusion of secundum atrial septal defects is a safe and effective alternative to traditional surgical closure; however, it is associated with serious occasional complications and inapplicable to more than 20% of atrial septal defects. In 2000, transthoracic occlusion was pioneered at Xijing Hospital as a novel method of atrial septal defect closure. The purpose of this study is to report the early and mid-term results of the transthoracic occlusion procedure and to evaluate its safety and efficacy. METHODS From April 2000 to April 2006, 268 patients with atrial septal defects were classified into 2 groups: group A (unsuitable for transcatheter occlusion, n = 126) and group B (n = 142). The transthoracic occlusion method used transesophageal echocardiographic-guided atrial septal defects occluder deployment via a right minithoracotomy without cardiopulmonary bypass or fluoroscopy. RESULTS Device implantation was successful in 265 patients (98.9%), including 9 elliptical devices in group A. The average size of circular occluders in group A was 38.2 ± 4.2 mm, which was larger than in group B (24.0 ± 4.5 mm) (P < .001). The average procedure time was 37.2 ± 9.2 minutes, the average intracardiac manipulation time was 5.8 ± 3.0 minutes, and the average inpatient stay was 3.2 ± 0.8 days. Twenty-five complications (9.3%) occurred in patients during the follow-up period. No large residual shunting, device embolization, or other severe complications resulted from transthoracic occlusion. CONCLUSIONS Transthoracic occlusion is a new safe and effective method for atrial septal defect treatment, even for patients with partial atrial septal defects unsuitable for transcatheter occlusion. This hybrid method broadens the indications of atrial septal defect treatment with device occlusion.
Collapse
Affiliation(s)
- Xufeng Wei
- Institute of Cardiovascular Surgery, Xijing Hospital, The 4th Military Medical University, Xi'an, Shaanxi Province, PR China
| | | | | | | | | | | | | |
Collapse
|
41
|
Stolt VS, Chessa M, Aubry P, Juliard JM, Schraeder R, Berger A, Goy JJ. Closure of ostium secundum atrial septum defect with the Atriasept occluder: early European experience. Catheter Cardiovasc Interv 2010; 75:1091-5. [PMID: 20517972 DOI: 10.1002/ccd.22394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This multicentre study sought to report the safety and efficacy of the ATRIASEPT septal occluder to repair atrial septal defect (ASD). BACKGROUND The ATRIASEPT is a low profile, flexible, double disk occluder with centering system specifically designed for closure of ostium secundum ASD. METHOD Patients were enrolled from four participating European sites and followed up for 12 months post procedure. Outcomes were evaluated, including closure success and incidence of adverse events. RESULTS Seventy-six patients received the ATRIASEPT device. Mean size of the defect was 15 +/- 4 mm. Closure success was observed in 69 patients (89%) at the end of the procedure. Sixty-four patients had a six-month follow up with a complete closure by 58 patients (90%). Minor adverse events occurred in two patients. Significant functional improvement was reported by all symptomatic patients. CONCLUSION Percutaneous closure of ASD ostium secundum type defects with the ATRIASEPT is safe and effective with high success rate and excellent mid-term outcome.
Collapse
|
42
|
Chen Q, Chen LW, Cao H, Zhang GC, Chen DZ, Zhang H. Intraoperative Device Closure of Atrial Septal Defect in Infants. Ann Thorac Surg 2010; 89:1250-4. [DOI: 10.1016/j.athoracsur.2010.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 01/04/2010] [Accepted: 01/04/2010] [Indexed: 10/19/2022]
|
43
|
Avila Alvarez A, Marcos-Alonso S, Rueda Núñez F, Abelleira Pardeiro C. [Fulfillment of the prevention of endocarditis guidelines after percutaneous closure of atrial septal defects]. An Pediatr (Barc) 2009; 71:407-11. [PMID: 19729355 DOI: 10.1016/j.anpedi.2009.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 06/24/2009] [Accepted: 06/25/2009] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION After the implantation of an intracardiac device for the closure of an atrial septal defect, most centres follow the guidelines for antibiotic prophylaxis to reduce the risk of infectious endocarditis, at least during the first 6 months after the implantation, if there is no evidence of residual shunt. The aim of this report is to evaluate the knowledge, fulfillment and adherence to the recommendations of our centre on the prevention of endocarditis, of the families of patients subjected to percutaneous closure of an ASD. PATIENTS AND METHODS We performed an observational retrospective study of 51 paediatric patients subjected to percutaneous closure of an ASD in the "Complejo Hospitalario Universitario de La Coruña", between 1999 and 2008. RESULTS A total of 51 procedures were performed, with an average of follow-up of 57.2 months. 75.7% of the families knew about the prophylaxis of endocarditis. This percentage was higher if less time had passed since the intervention and was also higher depending on the educational level of the parents. A total of 50% never stopped carrying out the endocarditis prophylaxis. In this case, a relationship was also observed, with the educational level of the parents and with the time passed since the intervention (P=0.004). The majority (73%) of the patients never had to carry out endocarditis prophylaxis. CONCLUSIONS The latest guidelines on antibiotic prophylaxis of endocarditis are increasingly restrictive in their indications in order to promote a more rational use of antibiotics. More studies are needed on the indications of antibiotic prophylaxis in endocarditis in patients with an intracardiac device, in order to establish concrete or evidence-based guidelines. Meanwhile, it is our responsibility to avoid the indiscriminate application of antibiotics, and involve the families and other health professionals.
Collapse
Affiliation(s)
- A Avila Alvarez
- Unidad de Cardiología Infantil, Complejo Hospitalario Universitario, A Coruña, España.
| | | | | | | |
Collapse
|
44
|
Rigatelli G, Cardaioli P, Giordan M, Dell'Avvocata F, Braggion G, Piergentili C, Roncon L, Faggian G. Transcatheter Intracardiac Echocardiography-Assisted Closure of Interatrial Shunts: Complications and Midterm Follow-Up. Echocardiography 2009; 26:196-202. [DOI: 10.1111/j.1540-8175.2008.00763.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
45
|
Lysitsas DN, Wrigley B, Banerjee P, Glennon PE, Parmar JM, Shiu MF, Been M. Presentation of an embolised Amplatzer septal occluder to the main pulmonary artery 2 years after implantation. Int J Cardiol 2009; 131:e106-7. [DOI: 10.1016/j.ijcard.2007.07.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 07/07/2007] [Indexed: 11/28/2022]
|
46
|
Karamlou T, Diggs BS, Ungerleider RM, McCrindle BW, Welke KF. The Rush to Atrial Septal Defect Closure: Is the Introduction of Percutaneous Closure Driving Utilization? Ann Thorac Surg 2008; 86:1584-90; discussion 1590-1. [DOI: 10.1016/j.athoracsur.2008.06.079] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Revised: 05/26/2008] [Accepted: 06/02/2008] [Indexed: 12/01/2022]
|
47
|
Maschietto N, Bonato R, Milanesi O. Is it possible to percutaneously close an atrial septal defect in babies who weigh less than four kilograms? Report of a successful case. J Cardiovasc Med (Hagerstown) 2008; 9:929-31. [DOI: 10.2459/jcm.0b013e3282fec084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
48
|
Raffa GM, Pellegrini C, Lentini S, Perrotta S, Tancredi F, Gaeta R, Viganò M. Minimally Invasive Video-Assisted Surgery for Iatrogenic Aortic Root-to-Right Atrium Fistula After Incomplete Percutaneous Occlusion of Patent Foramen Ovale: Case Report and Review of the Literature. J Card Surg 2008; 23:75-8. [DOI: 10.1111/j.1540-8191.2007.00483.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
49
|
Hongxin L, Wenbin G, Lijun S, Zhengjun W, Hao L, Chengwei Z, Liang D, Guidao Y. Intraoperative device closure of secundum atrial septal defect with a right anterior minithoracotomy in 100 patients. J Thorac Cardiovasc Surg 2007; 134:946-51. [PMID: 17903512 DOI: 10.1016/j.jtcvs.2007.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Revised: 04/24/2007] [Accepted: 05/02/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aims to report our experience using intraoperative device closure of secundum atrial septal defects and to evaluate the feasibility and clinical outcome of this technique. METHODS One hundred patients with secundum atrial septal defects (mean age, 29 +/- 16 years; age range, 5-71 years; mean weight, 54 +/- 18 kg; weight range, 16-94 kg) underwent intraoperative device closure through a right minithoracotomy without cardiopulmonary bypass and fluoroscopy. A 2.5- to 3-cm parasternal or submammary incision was made in the right third or fourth intercostal space. Exposed with a miniretractor, a specially designed plastic sheath loaded with the device was inserted through the purse-string sutures placed on the right atrium. Under transesophageal echocardiographic guidance, it was advanced through the atrial septal defect into the left atrium, and the device was deployed in place. RESULTS The procedure was successful in all patients, including 5 patients with double atrial septal defects. The maximum diameter of the atrial septal defect ranged from 5 to 37 mm (mean, 21 +/- 7 mm). There were 61 patients with an atrial septal defect diameter of more than 20 mm, 16 of them with a diameter of more than 30 mm. The mean size of implanted devices was 25 +/- 7 mm (range, 8-36 mm). Residual shunts were found in 9 (9%) patients immediately after the operation. The complete occlusion rate was 95% at discharge, 99% at the 3-month follow-up, and 100% at the 1-year follow-up. There were no other late complications during the follow-up period. CONCLUSIONS Intraoperative device closure is a safe, cost-effective, cosmetic, and less-invasive operation of most secundum atrial septal defects. Follow-up results are encouraging. It can be considered an acceptable alternative to transcatheter closure or surgical repair.
Collapse
Affiliation(s)
- Li Hongxin
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Dixon SR, Grines CL, O'Neill WW. The Year in Interventional Cardiology. J Am Coll Cardiol 2007; 50:270-85. [PMID: 17631221 DOI: 10.1016/j.jacc.2007.04.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 03/22/2007] [Accepted: 04/04/2007] [Indexed: 02/05/2023]
Affiliation(s)
- Simon R Dixon
- Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
| | | | | |
Collapse
|