From the Guidelines
ASD closure devices rarely require repair with open heart surgery after placement, with the need for surgical intervention following device placement occurring in approximately 0.5-1% of cases. Most ASD devices remain securely in place for a lifetime without complications. The most common reasons for surgical intervention include device embolization (when the device moves from its intended position), erosion into cardiac structures, persistent significant shunting around the device, or infection 1. These complications typically occur within the first year after implantation, with the risk decreasing substantially thereafter. Patients who receive ASD closure devices require regular follow-up with echocardiograms initially at 1 month, 6 months, and 1 year post-procedure, then annually for several years to monitor device position and function. The long-term durability of these devices is excellent, with most patients never requiring additional interventions. This high success rate is why transcatheter ASD closure has become the preferred approach over traditional open heart surgery for most suitable defects.
Some key points to consider when evaluating the need for ASD device repair include:
- The type of ASD, with secundum defects being the most common and amenable to device closure 1
- The size of the defect, with larger defects potentially requiring surgical closure 1
- The presence of complications, such as device embolization or erosion into cardiac structures 1
- The patient's overall health and medical history, with factors such as pulmonary hypertension or prior cardiac surgery potentially influencing the decision to repair or replace the device.
In general, the decision to repair or replace an ASD closure device should be made on a case-by-case basis, taking into account the individual patient's unique circumstances and medical history. However, the overall incidence of device failure or complications requiring open heart surgery is relatively low, and most patients can expect excellent long-term outcomes with transcatheter ASD closure.
From the Research
ASD Device Repair Frequency
- The frequency of ASD device repair with open heart surgery is not directly stated in the provided studies 2, 3, 4, 5.
- However, study 2 mentions that residual shunts were more common with the transcatheter approach (3.9%) compared to the surgical approach (0.95%), which may indicate a need for repair in some cases.
- Study 5 compares totally thoracoscopic surgery with open surgery for ASD closure and finds no significant difference in mortality and major in-hospital complications between the two groups.
Surgical Repair Outcomes
- Study 3 compares surgical repair of ASD via median sternotomy, right submammary thoracotomy, and right vertical infra-axillary thoracotomy, and finds no significant difference in operative time, duration of cardiopulmonary bypass, and postoperative complications.
- Study 4 compares minimally invasive cardiac surgery (MICS) with median sternotomy for ASD closure and finds that MICS is associated with shorter length of incision, less temporary pacemaker wire insertion, and shorter postoperative length of stay.
- Study 2 finds that MICS for ASD is a safe procedure and compares favorably to transcatheter closure, with a higher treatment efficacy and lower complication rate.