1. The Rush to Atrial Septal Defect Closure: Is the Introduction of Percutaneous Closure Driving Utilization? 
Tara Karamlou, MD, Brian S. Diggs, PhD, Ross M. Ungerleider, MD, MBA, Brian W. McCrindle, MD, MPH, Karl F. Welke, MD, MS 
The Annals of Thoracic Surgery 
Volume 86, Issue 5, Pages (November 2008)
DOI: /j.athoracsur
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Proportion of each atrial septal defect (ASD) and patent foramen ovale (PFO) closure type normalized to population growth over an 18-year period. Percutaneous closure began to increase in 2001, and supplanted surgical closure as the dominant method of ASD/PFO closure by (Dark gray area = surgical repair; light gray area = catheterization repair; open area = unknown type of repair.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
Annual average number of atrial septal defect (ASD) and patent foramen ovale (PFO) closures as a function of patient age. A dramatic rise in the annual number of ASD closures per capita is seen among patients aged more than 40 years in the most recent year sextile. (Diamonds = 1988–1990; squares = 1991–1993; triangles = 1994–1996; crosses = 1997–1999; circles = 2000–2002; vertical slash = 2003–2005.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Atrial septal defect (ASD) and patent foramen ovale (PFO) closure type among adult (those aged more than 18 years) at the time of closure. More than 80% of patients undergoing percutaneous closure after 2003 are adults. The Y axis denotes the percent of ASD closures and the X axis shows the year sextiles stratified by closure type. (Light gray = surgical closure; dark gray = percutaneous closure.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
Number of atrial septal defect (ASD) and patent foramen ovale (PFO) repairs per closure type per year as a function of patient age. In earlier years, surgical closure (SC) type was dominated by patients under the age of 10 years. Over time, the proportion of percutaneous closures (PC) exceeded surgical closures, largely as a result of closure among patients aged more than 40 years. Note the increasing number of older patients undergoing surgical closure as well. (Diamonds/dashed line = PC 1988–1993; squares/dashed line = PC 1994–1999; triangles/dashed line = PC 2000–2005; diamonds/solid line = SC 1988–1993; squares/solid line = SC 1994–1999; triangles/solid line = SC 2000–2005.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

6. Fig 5
Percent of atrial septal defect (ASD) and patent foramen ovale (PFO) closures that are percutaneous closures (PC) as a function of increasing hospital volume (powers of 2) over time. There has been a nearly linear rise in the percent of PC over time, and this has been most prominent in hospital performing more than nine ASD/PFO closures per year. The highest volume hospitals (> 16 cases/year) were also early adopters of PC, with a sharp increase in PC in In contrast, escalating PC volume was not noted in lower volume hospitals (< 8 cases/year) until 2002.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

7. Fig 6
Indications for atrial septal defect (ASD) and patent foramen ovale (PFO) closure were significantly less prevalent among the patients undergoing percutaneous closure (hatched bars) as compared with patients undergoing surgical closure (black bars [*p < 0.001]). Importantly, this was true even in the recent era, after 2001, when percutaneous closure incidence exceeded surgical closure incidence.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions