Transcatheter Device Closure of Atrial Septal Defects A Safety Review (original) (raw)
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Journal of Ayub Medical College, Abbottabad : JAMC
Device closure of Secundum atrial septal defect (ASD) is an accepted mode of treatment in selected patients with a suitable defect. The major initial concern over the long-term outcome has been erosions and more recently development of aortic regurgitation. Objective was to assess the intermediate and long term outcome of patients with device closure of ASD with special reference to complications. Two hundred and four patients with significant Secundum ASD, 16 months to 55 years (median 8 years) were considered for transcatheter closure with the Amplatzer septal occluder from October 1999 to April 2009 with follow up examinations at 1, 3, 6, and 12 months and thereafter at yearly interval. Device closure of ASD was done successfully in 202/204 patients. The immediate (first 24-hour) major complications included device embolization (n = 4), pericardial effusion (n = 1) and 2:1 heart block (n = 1). At a mean follow up of 4.9 years (90 days to 9.6 years, median 5.3 years) complete clos...
Outcomes after ASD Repair in Adulthood : Surgical Closure vs Percutaneous Device Closure
International Journal of Research Publications
Various studies comparing surgical and percutaneous device closure in adult ASD patients showed different results. Thus, this literature review aims to determine outcomes in adult patients receiving surgical and percutaneous device closure by comparing articles. The articles were searched and filtered in PubMed, Google Scholar, and ScienceDirect databases. The years for articles included in this review were between 2017 and 2022. Only articles discussed the comparison between surgical and device differences included in this review. The exclusion criteria are articles containing only surgical or device closure outcomes. Eight articles met the criteria and were reviewed and chosen based on the aims, sample criteria, repair technique, and the result. This review resulted in similar outcomes in both surgical and device groups. There were slight differences, such as more extended hospital stays, more ECG abnormalities in surgical groups, and incomplete closure in device groups. It was concluded that both techniques effectively treat ASD without significant problems.
Catheterization and Cardiovascular Interventions, 2014
Objectives: To evaluate the feasibility, safety, and efficacy of implantation of the new Nit Occlud ASD-RV R (NOASD-R) device for percutaneous closure of ostium secundum atrial septal defects (ASD-OS). Background: Device catheter implantation has become the method of choice for most patients with ASD-OS. No single device has proven to be ideal for this type of procedure. The NOASD-R has a distinct design that may help to overcome limitations of other devices. Methods: A prospective, single arm, observational study including all consecutive patients receiving the NOASD-R device for ASD-OS closure between October 2011 and September 2013 was performed. Patient selection, device design, deployment technique, complications, and procedural outcomes were evaluated. Results: Seventy-four patients underwent attempted transcatheter ASD-OS closure using the NOASD-R device. Implantation of the occluder was successful in 73 patients (98.6%). The majority of patients were female (79.5%) with a median age of 17.2 years (range: 2-74). A 2-D transthoracic color-Doppler echocardiogram (TTE) obtained at the 3 or 6 month follow-up visit showed complete occlusion of the ASD-OS in 72/73 patients (98.6%). At a mean follow-up interval of 11.4 6 6.8 months there have been no episodes of late device embolization, cardiac perforation or erosion, endocarditis, thromboembolism, wire fracture, embolic neurologic events, or death. Conclusions: We report the first worldwide clinical experience using the NOASD-R device for ASD-OS closure. The procedure was feasible, with a high rate of successful implantations, and safe. High ASD-OS closure rates and no complications were encountered during short-term follow-up. V C 2014 Wiley Periodicals, Inc.
Predictive Factors for Patients Undergoing ASD Device Occlusion Who "Crossover" to Surgery
Pediatric cardiology, 2017
The aim of this study was to define characteristics of those patients who are referred for device closure of an Atrial septal defect (ASD), but identified to "crossover" surgery. All patients who underwent surgical and device (Amplatzer or Helex occluder) closures of secundum ASDs from 2001 to 2010 were reviewed and organized into three groups: surgical closure, device closure, and "crossover" group. 369 patients underwent ASD closure (265 device, 104 surgical). 42 of the 265 patients referred for device closure "crossed over" to the surgical group at various stages of the catheterization procedure. The device group had defect size measuring 14.2 mm (mean) and an ASD index (Defect Size (mm)/BSA) of 14.0 compared to the corresponding values in the surgical group (20.1 mm, ASD index 25.9) (P < 0.001) and in the "crossover" group (20.7 mm, 22.6 ASD index) (P < 0.001). 79 patients in the device group had a deficient rim, and 86% were located...
follow-up Transcatheter closure of atrial septal defect in young children: Results and
2010
This study sought to analyze the safety, efficacy, and follow-up results of percutaneous closure of secundum atrial septal defect (ASD) in young children. BACKGROUND Results of ASD transcatheter closure in adults are widely reported but there are no large published series concerning young children. METHODS Between December 1996 and February 2002, 48 of 553 patients percutaneously treated at our institution were children age Յ5 years. Indications for closure were: elective closure in 32 patients; frequent respiratory infections in 8; failure to thrive in 2; liver transplantation in 5; and a fenestrated Fontan in 1. The procedure was carried out under general anesthesia with fluoroscopy and transesophageal control. Two different devices were used: 1) the Cardio-SEAL/StarFLEX (CS/SF) and 2) the Amplatzer septal occluder (ASO). Basal physical examinations and echocardiograms were performed prior to the procedure and at follow-ups (1, 6, and 12 months, and yearly thereafter). RESULTS The mean age at closure was 3.6 Ϯ 1.3 years. A CS/SF was used in 10 subjects; an ASO was used in 38 patients. No deaths or immediate major complications occurred. The total occlusion rate was 87% at procedure, rising to 94% at discharge. The mean follow-up was 18 Ϯ 14 months. No midterm major or minor complications occurred. The occlusion rate rose to 100% at 12 months of follow-up. Symptomatic patients improved significantly. CONCLUSIONS In the current era and in experienced hands, ASD closure can be performed safely and successfully, even in very young children.
Atrial septal defect (ASD) device trans-catheter closure: limitations
Journal of Thoracic Disease, 2018
Systematic review Transcatheter closure is a widespread technique used to treat secundum atrial septal defects (ASDs). When compared to surgery, it provides a less invasive approach with quicker recovery and reduced physical and psychological impact (1-4). The first case was performed in 1976 by King and Mills (5). However, the percutaneous ASD closure fully entered the clinical arena with the introduction of Amplatzer septal occluder devices (ASO) (6). Since then, many other devices have been developed and used, such as the Gore Cardioform septal occluder (GSO), the Figulla Flexible Occlutech device, the Cardioseal/Starflex and the bio absorbable devices Biostar or Biotrek (7,8). Nowadays, almost 85-90% of all secundum ASD can be closed by using a transcatheter approach (9,10). However, several limitations may have a significant impact on the feasibility and success of percutaneous ASD closure (11,12). Limitations can be grouped as follows: (I) anatomical limitations; (II) device-related limitations; (III) associated defects and natural history associated issues; (IV) physiological limitations; (V) complications. Anatomical limitations A common underlying structure apply to all available devices: they are made of two disks and a connecting segment that keeps them together across the ASD. Two different engineering concepts have been developed, so that occluder devices can be classified as self-centering and nonself-centering ones. The Amplatzer and the Amplatzer-like devices, in which a central connecting waist fills the defect improving stability and occlusion, belong to the former, while devices such as GSO, where the connecting segment is linear, belong to the latter. All the currently available devices need to have surrounding "walls" supporting their stability. In particular, the disks of non-self-centering ones should be 1.8-2 times the diameter of the defect in order to have complete defect closure and avoid mal position or embolization (8). Main anatomical limitations to percutaneous ASD closure may be insufficient surrounding rims, multiple defects and excessively bulging atrial septal aneurisms (ASA). Typical of ostium primum ASD and sinus venosus-type defects, deficiency of surrounding rims can affect ostium