Long-Term Outcomes After Surgical Versus Transcatheter Closure of Atrial Septal Defects in Adults

ObjectivesThe purpose of this study was to assess the comparative effectiveness and long-term safety of transcatheter versus surgical closure of secundum atrial septal defects (ASD) in adults.BackgroundTranscatheter ASD closure has largely replaced surgery in most industrialized countries, but long-term data comparing the 2 techniques are limited.MethodsWe performed a retrospective population-based cohort study of all patients, ages 18 to 75 years, who had surgical or transcatheter ASD closure in Québec, Canada's second-largest province, using provincial administrative databases. Primary outcomes were long-term (5-year) reintervention and all-cause mortality. Secondary outcomes were short-term (1-year) onset of congestive heart failure, stroke, or transient ischemic attack, and markers of health service use.ResultsOf the 718 ASD closures performed between 1988 and 2005, 383 were surgical and 335 were transcatheter. The long-term reintervention rate was higher in patients with transcatheter ASD closure (7.9% vs. 0.3% at 5 years, p = 0.0038), but the majority of these reinterventions occurred in the first year. Long-term mortality with the transcatheter technique was not inferior to surgical ASD closure (5.3% vs. 6.3% at 5 years, p = 1.00). Secondary outcomes were similar in the 2 groups.ConclusionsTranscatheter ASD closure is associated with a higher long-term reintervention rate and long-term mortality that is not inferior to surgery. Overall, these data support the current practice of using transcatheter ASD closure in the majority of eligible patients and support the decision to intervene on ASD with significant shunts before symptoms become evident

Predictors of radial artery size in patients undergoing cardiac catheterization: Insights from the good radial artery size prediction (GRASP) study

Background: Radial artery occlusion occurs after transradial cardiac catheterization or percutaneous coronary intervention. Although use of a sheath larger than the artery is a risk factor for radial artery occlusion, radial artery size is not routinely measured. We aimed to identify bedside predictors of radial artery diameter. Methods: Using ultrasound, we prospectively measured radial, ulnar, and brachial artery diameters of 130 patients who presented for elective percutaneous coronary intervention or diagnostic angiography. Using prespecified candidate variables we used multivariable linear regression to identify predictors of radial artery diameter. Results: Mean internal diameters of the right radial, ulnar, and brachial arteries were 2.44 ± 0.60, 2.14 ± 0.53, and 4.50 ± 0.88 mm, respectively. Results for the left arm were similar. The right radial artery was larger in men than in women (2.59 vs 1.91 mm; P \u3c 0.001) and smaller in patients of South Asian descent (2.00 vs 2.52 mm; P \u3c 0.001). Radial artery diameter correlated with wrist circumference (r2 = 0.26; P \u3c 0.001) and shoe size (r2 = 0.25; P \u3c 0.001) and weakly correlated with height (r2 = 0.14; P \u3c 0.001), weight (r2 = 0.18; P \u3c 0.001), body mass index (r2 = 0.07; P = 0.002), and body surface area (r2 = 0.22; P \u3c 0.001). The independent predictors of a larger radial artery were wrist circumference (r2 = 0.26; P \u3c 0.001), male sex (r2 = 0.06; P \u3c 0.001), and non-South Asian ancestry (r2 = 0.05; P = 0.006; final model r2 = 0.37; P \u3c 0.001). A risk score using these variables predicted radial artery diameter (c-statistic, 0.71). Conclusions: Wrist circumference, male sex, and non-South Asian ancestry are independent predictors of increased radial artery diameter. A risk score using these variables can identify patients with small radial arteries. © 2014 Canadian Cardiovascular Society