Outcome of Atrial Septal Closures, Catheterizations vs Surgery

Abstract

Background: Atrial septal defects (ASDs) are common congenital heart defects in children, with secundum ASD being the most prevalent. While surgery was once the main treatment, catheter-based closure now offers a less invasive alternative. Treatment choice depends on factors such as the child’s age, defect size and location, and overall health. The aim of the study:  is to identify the optimal ASD closure strategy in children by comparing the effectiveness and complication rates of surgical and transcatheter closure approaches Methods: This retrospective study analyzed 114 children (ages 2–20) with ASD who underwent surgical or transcatheter closure at Sulaymaniyah Cardiac Hospital and Anwar Sheikha Medical City between 2007 and 2023. Transthoracic echocardiography guided diagnosis and follow-up. Outcomes assessed included procedural success, complications, mortality, hospital stay, recovery time, recurrence, and reintervention. Results: This study included 114 children with a median age of 5 years; ASD was more common in females, particularly with larger defects. Most patients were from Sulaymaniyah, and over half had large ASDs. Treatments included transcatheter closure and surgery. The majority had no postoperative complications, though complication rates were slightly higher after surgery. Treatment selection depended on defect size, with larger ASDs typically managed surgically. Surgery was mainly performed in public hospitals, offering lower costs but potentially longer wait times. Conclusion: Surgical ASD closure was associated with higher costs and more complications than transcatheter closure. Larger defects were more often treated surgically, highlighting the need for personalized treatment based on defect size, patient factors, and resource availability.