ASD Repair in Adolescent and Adult Patients, and Establishing a Heart Team in Low-Volume Centres: Should it be the Current Standard of Care?

Abstract

Objectives: A retrospective review of adolescent and adult patients with\nAtrial Septal Defect (Secundum ASD) who underwent secundum ASD closure\nby transcatheter closure (TCC) or surgery at Jordan University Hospital\n(JUH). We seek to illustrate the importance of a multidisciplinary Heart\nTeam in low-volume centres, and report the experience and outcomes of\nthis approach. Methodology: A retrospective observational study of 42\npatients who underwent secundum ASD closure by TCC or surgery at JUH. We\nutilised the hospital’s electronic record system to attain patients’\ninformation, and SPSS and Microsoft Excel were used to analyse the data.\nResults: 42 patients with secundum ASD were treated during the period\nbetween January 2015 and December 2019. The mean age of participants was\n34.1 (± 14.3). A total of 34 patients underwent TCC, seven surgical\nclosure, and one a hybrid approach. There were no incidents of\nmortality, but two minor morbidities were reported. After an average\nfollow-up period of 13.2-/+13.6 months, with a range of 1-47 months ,\nmost patients experienced an improvement in their symptoms. There was\nalso a significant reduction of the right ventricular dimension:\nConclusion: A Heart Team approach is necessary as the use of minimally\ninvasive cardiac surgery MICS and Transcatheter closure TCC continues to\nadvance. A Heart Team provides patients with a variety of safe and\ncosmetic solutions that facilitate rapid management and recovery by\nencouraging the merits and avoiding the complications of each modality.\nUltimately, the Heart Team allows low-volume centres to achieve\nexcellent outcomes.