The gold standard for atrial septal defect closure: current surgical results, with an emphasis on morbidity.

Device closure of atrial septal defects (ASDs) is rapidly becoming routine in children. Comparisons are often made to older surgical series with higher morbidities. However outcomes including reintervention, late failure, and the need for long-term follow-up must be considered and compared to those of a current surgical series. One hundred consecutive surgical closures of ASDs in children were reviewed. The mean age was 60.5 +/- 6.4 months; 6 patients underwent repair in the first year of life. Full clinical and echocardiographic follow-up was available on all patients. There was no mortality; there were no residual ASDs and no neurological complications. There were 3 cases of postpericardiotomy syndrome and 26 pericardial effusions. Median stay was 4 days; all patients have been discharged from follow-up. A review of the literature on the short-term follow-up of ASD devices revealed a number of problems. Their long-term durability is unknown. As such, it remains an experimental procedure and must be compared over the long-term to the current gold standard, surgical repair.