Complications after percutaneous device closure of atrial septal defects in children: Prevalence, outcomes and associated factors.

Background: Atrial septal defects (ASDs) represent 10% of congenital heart disease. Transcatheter closure is the standard of care for anatomically suitable defects, but pediatric long-term outcomes remain underreported. This study examined the prevalence, outcomes, and risk factors for complications following ASD device closure in children. Methods: We retrospectively reviewed children <18 years undergoing transcatheter ASD closure at a single tertiary center (1989-2016). Demographic, procedural, and follow-up data were analyzed. Kaplan-Meier methods assessed freedom from major complications and associations with device type, imaging technique, and concomitant congenital heart disease (CHD). Results: A total of 971 children (mean age 8.2 ± 4.2 years, 62% female) underwent closure, with median follow-up 2.2 years (maximum 20.7). Concomitant CHD was present in 33%. Major complications occurred in 1.6%, including device embolization (0.6%), erosion (0.4%), and urgent surgery (0.6%). Rates were highest with early-era devices (8%). Kaplan-Meier analysis showed freedom from major complications of 98.1% at 5 years and 97.6% at 10 years. No significant differences were observed by imaging modality (ICE vs. TEE) or presence of concomitant CHD. Conclusions: In this large pediatric cohort, transcatheter ASD closure was associated with low rates of major complications and excellent long-term outcomes. Neither concomitant CHD nor imaging technique significantly affected complication risk. These findings reinforce the long-term safety of ASD device closure in children.