ArticleJournal of the American Heart Association2025
Outcomes Analysis of Transcatheter Closure of Atrial Septal Defects.
Article in Journal of the American Heart Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
backgroundAtrial septal defect device closure is routine, yet clinical success and long-term outcomes are often overlooked. We aim to identify predictive factors for failure and describe long-term outcomes.
methodsA single-center retrospective review (2006-2021) of 400 patients undergoing transcatheter atrial septal defect closure was conducted. Primary end point was 6-month composite clinical success, including technical success (implantation and device retention), closure success (trivial/no residual shunt), absence of 30-day serious adverse events, and no device removal/reintervention. Secondary end points were technical success, procedure success (technical success with less than moderate residual shunt), closure success (clinically insignificant/absent residual shunt), and safety.
resultsThe cohort included 43.2% males, with a median age of 14.5 years [Q1-Q3: 8.3-37] and weight of 47.5 kg [25-68]. At baseline, the median stop-flow defect diameter was 24 mm [18.9-29]; 22.3% had a diameter ≥30 mm, 4.9% had a diameter-to-weight ratio of 1.5-1.8, 17.7% were multi-fenestrated, 39.3% had margin deficiency, and 10.7% had an atrial septal aneurysm. A single device was used in 98.8% of procedures (75.7% Amplatzer, 23.0% Occlutech). Median difference between device size and balloon-sizing diameter was 1 mm [0-2]. Implantations were pulmonary vein-assisted in 26.8%, guidewire-assisted in 2.5%, and balloon-assisted in 3.8%. Technical success at hospital discharge was 95.8%, and procedural success was 94.8%. Closure success was 98.7% (377/382) at 6 months and 98.9% (193/194) at 96 months. Freedom from SAEs was 95.5% at 30 days. Freedom from device events was 97.4% at 6 months. Six-month composite clinical success rate was 89.3%. Balloon-assisted implantation (odds ratio [OR], 4.494, [95% CI 1.471-13.729]), guidewire-assisted implantation (OR 6.559 [95% CI 1.759-24.454]), and smaller device-to-balloon sizing difference (OR 0.8000 [95% CI 0.663-0.967]) were independent predictors of failure.
conclusionsTranscatheter atrial septal defect closure shows high success, with balloon- and guidewire-assisted implantations and smaller device-to-balloon-sizing differences as predictors of clinical failure.
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