Background : Our purpose is to assess the current management of ASD closure in an era of increasing feasibility of transcatheter device closure.
Methods : During the last decade surgical ASD closure was performed by complete sternotomy in 165 patients (group 1) and by a partial inferior sternotomy in 53 patients (group 2). Since September 1999 ASD occlusion was achieved by percutaneous device implantation in 82 patients, restricted only to ASD type II and patent foramen ovale (group 3).
Results : Major differences between the 3 groups are listed in the table.
| Full sternotomy | Mini sternotomy | Device | |
| Age (years) | 12,4 ± 17,5 | 9,8 ± 13,5 | 9,8 ± 13,525,2 ± 23,5 * |
| Adult/Children ratio | 39/126 | 11/42 | 43/39 * |
| Morbidity (n°) | 44 (26,7 %) | 7 (13,2 %) | 12 (14,6 %) |
| - Arrhythmia | 13 (7,9 %) | 3 (5,7 %) | 5 (6,5 %) |
| - Pulmonary complications | 6 (3,6 %) | 2 (3,8 %) | 1 (1,2 %) |
| - Pericardial effusion | 24 (14,5 %) | 6 (11,3 %) | 0 * |
| - Residual ASD | 1 (0,6 %) | 0 | 11 (13,4 %) |
| - Chest tube loss (ml/kg) | 11,6 ± 14,5 * | 7,1 ± 2,9 | - |
| Hospital stay (days | 8,3 ± 4,2 * | 5,9 ± 1,1 * | 2,1 ± 7,3 * |
Device occlusion had two major early complications needing surgery: 1 arteriovenous fistula and 1 device migration.
Midterm follow-up was commonly excellent but revealed 1 non-cardiac death and 1 reoperation for residual shunt in group 1, and 1 surgical removal for device thrombosis in group 3.
Conclusion : Percutaneous device occlusion has become an established treatment for ASD closure, achieving optimal results in older children and adults with anatomically suited ASD type II and PFO. However, a partial inferior sternotomy offers a valuable operative approach for all ASD variants, maintaining the predictable success of surgery, with the obvious advantages of a minimal access in terms of morbidity, cosmetics and hospital stay, and without supplementary costs.