Butera Gianfranco, Carminati Mario, Chessa Massimo, Youssef Rana, Drago Manuela, Giamberti Alessandro, Pomè Giuseppe, Bossone Edoardo, Frigiola Alessandro
Pediatric Cardiology, Istituto Policlinico San Donato, San Donato Milanese (MI), Italy.
Am Heart J. 2006 Jan;151(1):228-34. doi: 10.1016/j.ahj.2005.02.051.
Surgical closure of atrial septal defect (ASD) provides excellent results. Given the increasing popularity of percutaneous techniques, a comparison between the 2 methods is needed.
Between December 1988 and June 2003, we performed 1284 procedures in 1268 consecutive patients with isolated secundum ASD. Five hundred and thirty-three patients underwent surgical repair of ostium secundum ASD (group A). Seven hundred and fifty-one consecutive patients underwent percutaneous ASD closure (group B). The following outcomes were studied: mortality, morbidity, hospital stay, and efficacy.
There were no postoperative deaths. The overall rate of complications was higher in group A than in group B: 44% (95% CI 39.8%-48.2%) versus 6.9 % (95% CI 5%-8.7%) (P < .0001). Major complications were also more frequent in group A: 16% (95% CI 13%-19%) versus 3.6% (95% CI 2.2%-5.0%) (P = .002). Multiple logistic regression analysis showed that surgery was independently strongly related to the occurrence of total complication (odds ratio [OR] 8.13, 95% CI 5.75-12.20) and of major complications (OR 4.03, 95% CI 2.38-7.35). The occurrence of minor complications was independently related to surgery (OR 7.33, 95% CI 4.75-11.02), childhood (OR 1.52, 95% CI 1.01-2.34), and presence of systemic hypertension (OR 1.35, 95% CI 1.01-4.41). Hospital stay was shorter in group B (3.2 +/- 0.9 vs 8.0 +/- 2.8 days, P < .0001).
Percutaneous ASD closure provides, in experienced hands and in highly specialized centers, excellent results with a lower complication rate and requires a shorter stay in hospital.
房间隔缺损（ASD）的手术闭合效果良好。鉴于经皮技术越来越受欢迎，需要对这两种方法进行比较。
在1988年12月至2003年6月期间，我们对1268例连续的单纯继发孔型ASD患者进行了1284例手术。533例患者接受了继发孔型ASD的手术修复（A组）。751例连续患者接受了经皮ASD闭合术（B组）。研究了以下结果：死亡率、发病率、住院时间和疗效。
术后无死亡病例。A组的总体并发症发生率高于B组：44%（95%可信区间39.8%-48.2%）对6.9%（95%可信区间5%-8.7%）（P<.0001）。A组的主要并发症也更常见：16%（95%可信区间13%-19%）对3.6%（95%可信区间2.2%-5.0%）（P=.002）。多因素逻辑回归分析显示，手术与总并发症的发生（比值比[OR]8.13，95%可信区间5.75-12.20）和主要并发症的发生（OR 4.03，95%可信区间2.38-7.35）独立且密切相关。轻微并发症的发生与手术（OR 7.33，95%可信区间4.75-11.02）、儿童期（OR 1.52，95%可信区间1.01-2.34）和系统性高血压的存在（OR 1.35，95%可信区间1.01-4.41）独立相关。B组的住院时间更短（3.2±0.9天对8.0±2.8天，P<.0001）。
在经验丰富的医生手中以及高度专业化的中心，经皮ASD闭合术效果良好，并发症发生率较低，且住院时间较短。
