Cardiac remodeling and outcome after endovascular and minimally invasive closure of atrial septal defect in children

Abstract

Highlights. The article analyzes the features of cardiac remodeling and the outcomes of endovascular and minimally invasive closure of atrial septal defects in children.Aim. To compare the features of cardiac remodeling (CR) and the outcomes of endovascular and minimally invasive closure of atrial septal defects (ASD) in children.Methods. The study included 60 children with secundum ASD who underwent minimally invasive (MIC) or endovascular closure (EC) of ASD from the beginning of 2017 to the beginning of 2020. Patients were divided into two groups. The first group (n = 30) consisted of patients undergoing MIC, median age 5 years [2;12], and the second group (n = 30) consisted of patients undergoing EC, median age 5.5 years [1.7;13], p>0.05. The groups were comparable in gender, height, and body weight (p>0.05). The groups differed in the diameter of ASD. ASD defect size was 14 mm [7;30] in the MIC group, and 11.5 mm [7;22] in the EC group. The following indicators were assessed during hospital stay: the outcome of the intervention, residual shunt, hospital-acquired complications, and indicators that characterize CR before the procedure and 3-4 months after surgery.Results. The analysis revealed that all children successfully underwent minimally invasive and endovascular closure of ASD (confirmed absence of residual shunt). Hospital-acquired and long-term complications were not detected. Data are presented as a median and percentile. In the MIC group all patients required blood transfusion, intraoperative blood loss was 445 mL [300;1290], while in the EC group the blood loss did not exceed 5 mL [5;15], p = 0.001. EC was much more advantageous in terms of length of hospital stay (LoS) compared to MIC; in the MIC group LoS was 8 [6;14] days, and in the EC group LoS was 3 [3;4] days, p = 0.001. LoS in the Department of Anesthesiology and Intensive Care after MIC was 24 [3;96] hours, while patients in the EC group did not need to be transferred to this Department, p = 0.001. In both groups, significant changes were observed during 3–4-month follow-up in the form of a decrease in the volumetric and dimensional parameters of the right chambers and simultaneous increase in the same parameters of the left chambers.Conclusion. Minimally invasive and endovascular surgeries are effective and safe treatment modalities for ASD in children (median age of 5–5.5 years), which positively affect CR according to 3–4-month follow-up. At the same time, the advantages of EC regarding the intraoperative blood loss / blood transfusion, the need for mechanical ventilation, cardiopulmonary bypass, and LoS in the ICU and hospital are highlighted.