Objective : To audit the quality of the closure of an isolated ASD Secundum in Belgium. This includes the study of the variability in patient-population, diagnosis, surgical technique and outcome.
Methods : Since 01/01/97 all cardiac procedures (N=13530) performed in Belgium are reported, audited for accuracy and completeness. The 1997-dataset identified 169 repairs of isolated ASD Secundum in 20 centres. Appropriate variables described the variability in patients, procedures and outcome. The study interval was 1 year to include all early hazard beyond hospital stay. Complete follow-up was available in 94 % (as of date 01/08/1999).
Results : The age was 28 ± 25 years (1 month-78 years), including 65 children under 16 years (mean age 4.6 years). The female/male ratio was 2. The mean NYHA class was 1.6, only 23 pts were in NYHA > 2. Catheterisation was performed in 70% of the adults and 40% of the children. The mean QP/QS was 2.5 (1.3-5.0). Surgery was performed via sternotomy (92%), with cardioplegia (95%) and direct suture (52%).
The 30-day and 1-year survival was 99.3% and 98.7% respectively. Most patients were asymptomatic 1 year after ASD repair (92% in NYHA 1). Early morbidity was low (atrial arrhythmia in 6%). No recurrent ASD was observed at 1 year.
Conclusion : The audit of the ASD repair in Belgium identified high quality surgery. Surprisingly, 60% of the patients were adults with mild symptoms and significant shunts. Even in 1997, ASD is still diagnosed late in life. This successful audit methodology can be used as a substrate for other segments of surgical practice.