ASD Device Closure vs Open-Heart Surgery: Which Treatment Is Right for You?

A diagnosis of an atrial septal defect (ASD) may raise questions about the most appropriate treatment. An ASD is a congenital heart condition in which an abnormal opening in the wall (septum) separating the heart's two upper chambers (atria) allows extra blood to flow from the left atrium to the right atrium, increasing blood flow to the lungs.

Doctors might suggest ASD device closure or open-heart surgery depending on the size and location of the defect. Device closure is a procedure where a small closure device is placed through a catheter, usually threaded through a blood vessel in the groin, to plug the opening. In open-heart surgery, the chest is cut open to access the heart, and the defect is closed with a stitch or a surgical patch.

Knowing these procedures helps patients and carers discuss options with a heart specialist.

The ASD Device Closure Procedure

ASD device closure is a minimally invasive procedure that can treat most types of ASDs. For transcatheter ASD closure, the patient is given general anaesthesia or medications that sedate and make them sleepy and relaxed.

To perform a transcatheter ASD closure:

• A cardiologist makes a small incision in the femoral vein and sometimes also a femoral artery in your groin. They insert a thin tube called a catheter with the closure device at the end.
• They use imaging technology such as X-ray and echocardiography to guide the catheter and device through the vein to your heart.
• The doctor places the closure device into the hole, then removes the catheter.

For appropriately selected patients, device closure usually avoids a surgical chest incision and involves a shorter hospital stay and faster recovery than conventional surgery. However, it is not suitable for every ASD, and follow-up is needed to assess the device and confirm adequate closure.

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Open-Heart Surgery for ASD Closure

Open-heart surgery may be needed when an ASD is too large or complex to repair. Surgery can treat a broader range of ASDs (including many primum and sinus venosus types) that are generally not amenable to standard transcatheter device closure. Surgery may also be required when the same procedure can address associated anomalies.

 To perform an open-heart surgery:

The surgeon accesses the heart through an incision in the chest. Cardiopulmonary bypass, which temporarily takes over blood and oxygen delivery, is commonly used while the surgeon repairs the defect.

Depending on the defect's size and anatomy, the surgeon may close the opening directly with stitches or cover it with a patch.

Surgical repair is more invasive and generally involves a longer recovery than device closure.

Key Differences: ASD Device Closure and Open-Heart Surgery

Both procedures intend to close the defect, but they vary in how they access the heart, which defects they can treat, and what recovery involves.

What Could Be the Expected Benefits?

The Benefits of ASD Closure Include:

• Minimally invasive: ASD device closure is a minimally invasive procedure, as there is no large surgical incision, which results in smaller scars and less pain.
• Faster recovery: Patients frequently return to normal activities within a week, much faster than after open-heart surgery.
• Reduced hospital stays: Patients typically stay only 1-2 days.
• Lower risk of complications: Generally associated with fewer risks in comparison to traditional surgery.
• Effective closure: Can successfully close anatomically suitable secundum ASDs.

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The Benefits of Open-Heart Surgery:

• Wider range of defects: Open-heart surgery can deal with a much wider range of ASD types than device closure and is therefore an option in many cases where device closure is not appropriate. This includes many of the primum and sinus venosus types.
• Allows direct repair: Depending on the size and anatomy, the surgeon can close the opening with stitches or a patch.
• Other heart defects: Surgeons can correct other cardiac abnormalities requiring surgery during the same operation.
• Direct visualisation and control: The surgeon has direct control over the procedure, allowing immediate correction of any anatomical issues that may affect ASD closure

How Do Doctors Decide the Type of Surgery?

The choice of surgery depends on the individual patient's needs and the cardiology team's assessment. The doctor may consider several factors, such as:

• Type of ASD: the type of ASD directly influences the doctor's decision. The secundum ASDs are mainly treated with device closure, while many primum and sinus venosus defects require surgery.
• Size and location: the opening's dimensions and the surrounding tissue help determine which approach will best benefit the patient.
• Pulmonary pressure: properly assess increased pulmonary circulation pressure and elevated vascular resistance.
• Other heart conditions: associated conditions such as arrhythmia or valve disease may make surgery more appropriate.
• Patient age and overall health: these factors affect the procedure risk and likely recovery.

A multidisciplinary assessment is key before deciding whether and how to close the defect, especially in complex medical cases.

Recovery After ASD Closure: What Can the Patient Expect?

Recovery relies on overall health, the procedure, the patient's age, and associated factors.

After Device Closure

• Clinicians monitor the catheter insertion site and heart function as clinically indicated. Many patients can return to normal activities soon, unlike after conventional surgery.
• Follow-up appointments and cardiac imaging help assess the device's position and search for any remaining blood flow through the defect. The treating team may prescribe antiplatelet therapy after device closure, with the duration determined by the patient's risk factors.

After Open-Heart Surgery

• Recovery and hospital stay are generally longer. Care includes monitoring heart function, managing pain, looking after the surgical wound, and gradually increasing physical activity.
• Patients may be told to avoid heavy lifting and strenuous exercise during recovery. Follow-up appointments will monitor healing and heart function and look for any residual defect or other complications.
• Patients must follow the treating team's recovery guidance, since restrictions and needs vary from person to person.

Conclusion

Choosing between ASD device closure and open-heart surgery depends primarily on the defect’s type and anatomy, its impact on the heart, and the patient's overall health. Device closure is commonly preferred for suitable secundum ASDs because it is less invasive and typically allows a faster recovery. Surgery is still necessary for defects that cannot be safely closed with a device or that require additional cardiac repair.

Discuss your diagnostic findings, treatment options, possible risks, and expected recovery with a specialist experienced in congenital heart disease. Understanding why a specialist recommends a particular procedure can help you make an informed decision with your healthcare team.