nickel allergy. 6,7 Technological advances have made contemporary surgery less invasive than classical surgery using full sternotomy. Cardiac surgery performed without full sternotomy is called minimally invasive cardiac surgery (MICS). 8 Advantages of MICS are swift recovery and reduction of pain and sternal wound infection. Furthermore, it is cosmetically appealing, considering the higher prevalence of women and the relatively young population of patients with ASD compared with the typical

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... gical population. 9 MICS for ASD has been shown to be a safe procedure with satisfactory long-term outcomes. 10,11 More recently, MICS has used endoscopy through a small skin incision in the right chest wall, and is called a right mini-thoracotomy MICS. 12 The aim of this study was to compare percutaneous closure with right mini-thoracotomy MICS for secundum ASD because to date, no direct comparison has been made in terms of efficacy and safety. We also report data on the Background: Percutaneous closure has replaced surgery for the majority of cases of secundum atrial septal defect (ASD). However, technological advances have made contemporary minimally invasive cardiac surgery (MICS) less invasive than conventional surgery. The aim of this study was to compare clinical outcomes of percutaneous closure of secundum ASD with those of contemporary MICS. Methods and Results: We conducted a single-center retrospective study of 354 patients with ASD treated either with the Amplatzer Septal Occluder (134 patients) or MICS (220 patients) between 2000 and 2013. Success rates and the incidence of complications were compared. The success rates were 98% for percutaneous closure and 100% for MICS. There were no deaths in either group. Major complications occurred in 2 patients (1.5%) who underwent percutaneous closure and in 8 patients ( 3.6%) treated with MICS (P=0.16). Minor complications occurred in 15 patients (11.2%) who underwent percutaneous closure and in 46 patients (20.9%) treated with MICS (P=0.02). On multivariate analysis, MICS (odds ratio [OR]: 2.91, 95% confidence interval [CI]: 1.46-5.81; P=0.002) and age >70 years (OR: 3.50, 95% CI: 1.40-8.75; P=0.008) were independent predictors of complications. Conclusions: Percutaneous closure and MICS had high success rates without deaths. For ASD patients with a suitable anatomy, percutaneous closure can be considered as the first therapeutic option.