Very long-term outcomes of transcatheter secundum atrial septal defect closure using intracardiac echocardiography without balloon sizing

Transcatheter closure of atrial septal defect using intracardiac echocardiography: a two-center, retrospective study

AIMS

We present the experience and long-term results of intracardiac echocardiography (ICE)-guided closure of ostium secundum atrial septal defects (ASDs) in two Italian centers and investigate its systematic applicability as the gold standard in routine clinical practice.

METHODS

We retrospectively evaluated all consecutive patients who underwent an ASD percutaneous closure procedure from March 2008 to February 2020. All patients underwent a preprocedural transesophageal echocardiography (TEE) evaluation. The closures were carried out under fluoroscopic and ICE guidance. A follow-up visit was performed at 1, 3 and 12 months, followed by telephone evaluations approximately every 2 years.

RESULTS

Sixty-six patients (29% male individuals), mean age 43 ± 16 years, were treated. In 15 cases, the TEE defect diameter was less than 10 mm, and in 8 of these patients, the ICE intraprocedural sizing increased the maximum diameter by more than 5 mm. Sizing balloon of the defect was performed in 51 cases; 2 patients received an ASD 38 mm device. Eight patients had multiple defects; in three of these, it was necessary to apply two devices. Four patients showed nonsignificant residual shunt; no complications related to the use of ICE were observed. One patient presented the migration of the ASD device into the abdominal aorta, percutaneously retrieved with a snare. No major complications were recorded during the entire follow-up period.

CONCLUSION

This study confirms that ICE monitoring during ASD percutaneous closure is well tolerated and effective; it might be achievable as a routine gold standard by operators willing to use ICE systematically in all transcatheter closure interventions of interatrial communications.

Secundum atrial septal defects transcatheter closure: An updated reappraisal

Transcatheter device-based closure is considered the first line therapy for congenital secundum atrial septal defect (ASD). The last 20 years literature data have been reviewed to offer an updated reappraisal of current evidences. Anatomical and functional details, appreciated at both pre-procedural and intraprocedural steps, remain of paramount importance for planning ASD transcatheter -based closure procedure. Routes for interventions should include femoral, and eventually the jugular and hepatic vein approaches. Intraprocedural transoesophageal echocardiography (TTE) or intracardiac echocardiography (ICE) is used at least in most complex cases to have the exact definition of the anatomy of the defects. The clinical outcomes are excellent also compared to surgical series with few complications even compare to surgical series. Transcatheter ASD closure represents the first line therapy in secundum ASD. Future developments of device's material and imaging tools are expected to improve safety and long-term efficacy, even in most complex cases.

Transcatheter closure of atrial septal defect with deficient posterior-inferior or inferior vena cava rim under echocardiography only: a feasibility and safety analysis

BACKGROUND

The safe closure of atrial septal defect with deficient posterior-inferior or inferior vena cava rim is a controversial issue. Few studies have been conducted on the closure of atrial septal defect with deficient posterior-inferior or inferior vena cava rim without fluoroscopy. This study evaluated the feasibility and safety of echocardiography-guided transcatheter closure of atrial septal defect with deficient posterior-inferior or inferior vena cava rim.

METHODS

The data of 136 patients who underwent transcatheter atrial septal defect closure without fluoroscopy from March 2017 to March 2020 were retrospectively analysed. The patients were classified into the deficient (n = 45) and sufficient (n = 91) posterior-inferior or inferior vena cava rim groups. Procedure and the follow-up results were compared between the two groups.

RESULTS

Atrial septal defect indexed diameter and the device indexed diameter in the deficient rim group were both larger than that in the sufficient rim group (22.12 versus 17.38 mm/m2, p < 0.001; 24.77 versus 21.21 mm/m2, p = 0.003, respectively). There was no significant difference in the success rate of occlusion between two groups (97.78% in the deficient rim group versus 98.90% in the sufficient rim group, p = 1.000). During follow-up, the incidence of severe adverse cardiac events was not statistically significant (p = 0.551).

CONCLUSIONS

Atrial septal defect with deficient posterior-inferior or inferior vena cava rim can safely undergo transcatheter closure under echocardiography alone if precisely evaluated with transesophageal or transthoracic echocardiography and the size of the occluder is appropriate. The mid-term results after closure are similar to that for an atrial septal defect with sufficient rim.

Atrial septal defect in adulthood: a new paradigm for congenital heart disease

Atrial septal defects (ASDs) represent the most common congenital heart defect diagnosed in adulthood. Although considered a simple defect, challenges in optimal diagnostic and treatment options still exist due to great heterogeneity in terms of anatomy and time-related complications primarily arrhythmias, thromboembolism, right heart failure and, in a subset of patients, pulmonary arterial hypertension (PAH). Atrial septal defects call for tertiary expertise where all options may be considered, namely catheter vs. surgical closure, consideration of pre-closure ablation for patients with atrial tachycardia and suitability for closure or/and targeted therapy for patients with PAH. This review serves to update the clinician on the latest evidence, the nuances of optimal diagnostics, treatment options, and long-term follow-up care for patients with an ASD.

Secundum atrial septal defects transcatheter closure versus surgery in adulthood: a 2000-2020 systematic review and meta-analysis of intrahospital outcomes

INTRODUCTION

Technologically, advances in both transcatheter and surgical techniques have been continuing in the past 20 years, but an updated comprehensive comparison in device-based versus surgery in adults in terms of incidence of in-hospital mortality, perioperative stroke, and atrial fibrillation onset is still lacking. We investigate the performance of transcatheter device-based closure compared to surgical techniques by a systematic review and meta-analysis of the last 20 years literature data.

MATERIAL AND METHODS

The analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Literature search was performed based on Cochrane Library, Embase, PubMed, and Google Scholar to locate articles published between January 2000 and October 2020, regarding the comparison between short-term outcome and post-procedural complications of atrial septal defect patients receiving transcatheter or surgical closure. The primary outcome was the comparison of in-hospital mortality from all causes between patients treated with transcatheter closure or cardiac. Secondary outcomes were the onset of post-procedural atrial fibrillation or perioperative stroke.

RESULTS

A total of 2360 patients were included of which 1393 [mean age 47.6 years, 952 females (68.3%)] and 967 [mean age 40.3 years, 693 females (71.6%)] received a transcatheter device-based and surgery closure, respectively. In-hospital mortality [OR 0.16 (95% CI (0.66-0.44)), p = 0.0003, I2 = 0%], perioperative stroke [OR 0.51 (95% CI (0.31-0.84)), p = 0.003, I2 = 79%], and post-procedural atrial fibrillation [OR 0.14 (95% CI (0.03-0.61)), p = 0.009, I2 = 0%] significantly favoured transcatheter device-based closure.

CONCLUSION

Transcatheter atrial septal defect closure resulted safer in terms of in-hospital mortality, perioperative stroke, and post-procedural atrial fibrillation compared to traditional surgery.

Clinical evaluation of percutaneous and intra-operative device closure of atrial septal defects under transesophageal echocardiographic guidance: one center experience and mid-term follow-up

OBJECTIVE

The percutaneous closure of a single secundum atrial septal defect (ASD) under transesophageal echocardiography guidance as an accepted alternative to the transcatheter closure with fluoroscopy has been proven. However, the technique has not been routinely used. This study was to present and share our experience in comparing the clinical outcomes of the percutaneous and intra-operative device closure (IODC) of atrial septal defects without fluoroscopy.

METHODS

From January 2013 to December 2016, 103 patients with maximum diameters of ASD of less than 30 mm were allocated to groups taking either the percutaneous closure of atrial septal defects approach (PASD group, n = 53) or the intra-operative device closure approach (IODC Group, n = 50). They were operated on using the minimally invasive Amplatzer duct occluder under the guidance of transesophageal echocardiography without cardiopulmonary bypass. Echocardiography was performed to obtain an en face view of the ASD and important surrounding structures before the operation. Patient characteristics, perioperative data, and follow-up data were retrospectively documented and analyzed.

RESULTS

Patient characteristics were comparable between the two groups. These were no differences in the maximum diameters of defects and the size of the occluders in each group (16.4 ± 5.3 mm vs16.4 ± 5.2 mm, P = 0.98; 22.4 ± 5.8 mm vs 21.3 ± 6.6 mm, P = 0.38). Intracardiac manipulation time was 20.72 ± 7.70 min in the PASD group and 6.01 ± 1.03 min in the IODC group (P < 0.001). The procedure time was 28.70 ± 10.41 min in the PASD group and 39.13 ± 6.03 min in the IODC group (P < 0.001). The successful closure defect was 100% in both groups when the maximum diameter of defect less than 25 mm. Four patients the PASD groups with maximum diameters between 25 mm and 30 mm were transferred to the IOCD group after unsuccessful device implantations. The total occlusion rate was 82% immediately after deployment, 98% at 3 months, and 100% at 6 months. No cardiac-related complications occurred during the follow-up period of between 3 to 65 months (mean 21.4 ± 9.8 months).

CONCLUSIONS

Percutaneous device closures of Secundum atrial septal defects showed safety and high efficiency in patients under guidance by transesophageal echocardiography when compared with intra-operative device closures and are especially suited for women and children.