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Li A, Aboulhosn JA. Update on Transcatheter Interventions in Adults with Congenital Heart Disease. J Clin Med 2024; 13:3685. [PMID: 38999250 PMCID: PMC11242816 DOI: 10.3390/jcm13133685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024] Open
Abstract
The field of adult congenital interventions is unique in the world of cardiac catheterization, combining the structural concepts commonly employed in pediatric heart disease and applying them to adult patients, who are more amenable to device intervention as they no longer experience somatic growth. Rapid advances in the field have been made to match the growing population of adult patients with congenital heart disease, which currently surpasses the number of pediatric patients born with congenital heart disease. Many congenital defects, which once required surgical intervention or reoperation, can now be addressed via the transcatheter approach, minimizing the morbidity and mortality often encountered within adult congenital surgeries. In this paper, we aim to provide a focused review of the more common procedures that are utilized for the treatment of adult congenital heart disease patients in the catheterization laboratory, as examples of current practices in the United States, as well as emerging concepts and devices awaiting approval in the future.
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Affiliation(s)
- Angela Li
- Division of Cardiology, UCLA Medical Center, Los Angeles, CA 90095, USA;
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Xue YH, Huang IC, Tuan SH, Cheng CC, Cheng H, Lu YS, Chou CC, Chang YL, Lin KL. Cardiopulmonary functional capacity in Taiwanese children with atrial septal defects. J Chin Med Assoc 2024; 87:653-658. [PMID: 38666778 DOI: 10.1097/jcma.0000000000001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Most existing studies measure atrial septal defect (ASD) outcomes based on morbidity rates such as atrial arrhythmias and heart failure rather than the functional assessment of physical capacity postprocedure. Few studies have evaluated cardiopulmonary function in ASD children. This study represents the largest sample population in the current research, encompassing a total of 122 Taiwanese children with ASD who had undergone treatment, to evaluate cardiopulmonary functional capacity through the implementation of cardiopulmonary exercise testing (CPET), and to investigate whether variations in treatment may impact their cardiopulmonary function. METHODS This is a retrospective cohort study with the data collected from January 2010 to December 2021. All patients and controls (age-, sex-, and body mass index-matched) underwent CPET and pulmonary function testing. RESULTS In total, 122 ASD patients (surgically closed ASDs 27, transcatheter-closed ASDs 48, and follow-up unrepaired ASD 47) and 244 healthy controls were recruited. The ASD group exhibited lower peak metabolic equivalent (MET), peak oxygen consumption (VO 2 , p < 0.001), and peak minute ventilation ( p = 0.028) along with MET and VO 2 at the anaerobic threshold (AT) ( p = 0.012) compared to the control group. No statistically significant differences were observed in the pulmonary function test. Among surgically closed, transcatheter closed and unrepaired ASD subgroups, no significant variances were seen in CPET and pulmonary function tests. CONCLUSION Taiwanese ASD children exhibited diminished exercise capacity and cardiopulmonary performance compared to their healthy counterparts. Differences among specific ASD treatments in cardiopulmonary tests were non-significant.
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Affiliation(s)
- Yu-Hao Xue
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - I-Ching Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Sheng-Hui Tuan
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan, ROC
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Cheng-Chang Cheng
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Hsuan Cheng
- Department of General Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan, ROC
| | - Yen-Sen Lu
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Chia-Chun Chou
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Yung-Liang Chang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Ko-Long Lin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
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de Liyis BG, Kosasih AM, Jagannatha GNP, Dewangga MSY. Complications and Efficacies of Surgical Versus Transcatheter Closure for Pediatric Ostium Secundum Atrial Septal Defect: A Meta-Analysis. J Endovasc Ther 2024:15266028241245599. [PMID: 38597284 DOI: 10.1177/15266028241245599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
INTRODUCTION The optimal approach for pediatric ostium secundum atrial septal defect (ASD) closure remains uncertain. This study aims to assess complications and efficacies of surgical and transcatheter closures. METHODS Systematic search in Medline, Cochrane, and EMBASE databases identified cohort studies until July 2023. Complications, length of hospital stay, and efficacy outcomes were evaluated. Subgroup analyses considered ethnicity, ASD size, age, and rim deficiency involvement. RESULTS Fourteen cohort studies involving 9695 patients were comprehensively analyzed. Regarding complications, the pediatric patients in the surgery group exhibited higher occurrences of cardiac arrhythmia (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.22-2.87, p=0.004), pericardial effusion (OR: 14.80, 95% CI: 6.97-31.43, p<0.00001), and pulmonary complications (OR: 2.58, 95% CI: 1.73-3.85, p<0.00001) compared with those in the transcatheter group. However, no significant difference in fever incidence was observed (OR: 2.57, 95% CI: 0.90-7.34, p=0.08). Furthermore, length of hospital stay was notably shorter in the pediatric transcatheter group (mean difference [MD]: 4.00, 95% CI: 1.71-6.29, p=0.0006). Regarding efficacies, both groups demonstrated similar rates of successful closure (OR: 1.97, 95% CI: 0.56-6.92, p=0.29) and residual shunting (OR: 0.55, 95% CI: 0.17-1.77, p=0.31) in the pediatric cohort. Subgroup analyses revealed that surgical residual shunting was notably lower in the European pediatric population (OR: 0.18, 95% CI: 0.07-0.45, p=0.0002), in cases with ASD size exceeding 15 mm (OR: 0.19, 95% CI: 0.08-0.49, p=0.0006), and in pediatric patients younger than 8 years (OR: 0.33, 95% CI: 0.12-0.92, p=0.03). Interestingly, residual shunting involving complex ASD with rim deficiency was more pronounced in the surgery group (OR: 2.66, 95% CI: 1.33-5.32, p=0.006). CONCLUSIONS Both surgical and transcatheter closures are equally effective, with transcatheter closure showing significantly fewer complications. CLINICAL IMPACT This meta-analysis offers pivotal insights for clinicians grappling with the optimal approach to pediatric ostium secundum ASD closure. The observed higher incidence of cardiac arrhythmias, pericardial effusions, and pulmonary complications in surgical closures underscores the challenges associated with this modality. In contrast, transcatheter closure, with its comparable efficacy and shorter hospital stays, emerges as an appealing and less invasive alternative. These findings equip clinicians with evidence to make informed decisions, optimizing patient outcomes. Subgroup analyses further refine recommendations, emphasizing tailored considerations for European pediatric patients, larger ASDs, and those under 8 years old, ultimately fostering personalized and improved care strategies.
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Affiliation(s)
- Bryan Gervais de Liyis
- Faculty of Medicine, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Universitas Udayana, Denpasar, Indonesia
| | - Anastasya Maria Kosasih
- Faculty of Medicine, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Universitas Udayana, Denpasar, Indonesia
| | | | - Made Satria Yudha Dewangga
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Universitas Udayana, Denpasar, Indonesia
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Kauling RM, Pelosi C, Cuypers JAAE, van den Bosch AE, Hirsch A, Carvalho JG, Bowen DJ, Kardys I, Bogers AJJC, Helbing WA, Roos-Hesselink JW. Long term outcome after surgical ASD-closure at young age: Longitudinal follow-up up to 50 years after surgery. Int J Cardiol 2024; 397:131616. [PMID: 38030038 DOI: 10.1016/j.ijcard.2023.131616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To describe the clinical outcome and quality of life up to 50 years after surgical atrial septal defect (ASD) closure at young age. Primary outcome is defined as MACE (all-cause mortality, cardiac re-interventions, ischemic stroke, endocarditis, heart failure and symptomatic arrhythmia). METHODS Single-center, longitudinal cohort-study evaluating 135 consecutive patients who underwent ASD-closure before the age of 15 years between 1968 and 1980. Participants were invited for extensive cardiac evaluation and assessment of quality-of-life every 10 years. RESULTS Eighty patients (86%) of 93 eligible survivors were included in this study (mean age 52 ± 5 years (range 41-63), 40% male). Median follow-up since surgery was 45 years (range 40-51). Cumulative survival after 50 years was 86% and comparable to the normal Dutch population. Cumulative event-free survival after 45 and 50-years was 59% and 46% respectively (re-intervention in 6, symptomatic arrhythmia in 25, and pacemaker implantation in 10 patients). Right ventricular ejection fraction on CMR was diminished in 6%. Exercise capacity was normal in 77%. There was no pulmonary hypertension. NT-proBNP was elevated in 61%. Quality of life was comparable with the general population. No predictors for late events were identified. CONCLUSION Long-term survival after surgical ASD-closure in childhood is good and not statistically different at 50 years compared to the normal Dutch population. Re-intervention rate is low, there is no pulmonary hypertension. Right ventricular function was diminished in 6%, exercise capacity was good and stable over time with quality of life comparable to the general population. However, supraventricular tachycardia is common.
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Affiliation(s)
- Robert M Kauling
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands.
| | - Chiara Pelosi
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Judith A A E Cuypers
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - João G Carvalho
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Daniel J Bowen
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Isabella Kardys
- Clinical Epidemiology and Innovation Unit, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wim A Helbing
- Department of Pediatrics, division of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands
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Conde I, Salomé N, Sousa A, Quina C. Unveiling an Unusual Cause of Cardiac Tamponade. Cureus 2023; 15:e50984. [PMID: 38259365 PMCID: PMC10801674 DOI: 10.7759/cureus.50984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
This case presents a 48-year-old woman initially diagnosed with an ostium secundum atrial septal defect (ASD) at the age of 36. Twelve years post-intervention, she presented to the emergency department with cardiac tamponade. This case highlights the importance of maintaining prolonged follow-up for individuals undergoing percutaneous ASD closure, given the possibility of potentially fatal late complications of ASD occlusion devices.
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Affiliation(s)
- Inês Conde
- Cardiology, Hospital de Braga, Braga, PRT
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Perdreau E, Jalal Z, Walton RD, Sigler M, Cochet H, Naulin J, Quesson B, Bernus O, Thambo JB. Assessment of Nit-Occlud atrial septal defect occluder device healing process using micro-computed tomography imaging. PLoS One 2023; 18:e0284471. [PMID: 37093832 PMCID: PMC10124873 DOI: 10.1371/journal.pone.0284471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 04/01/2023] [Indexed: 04/25/2023] Open
Abstract
After percutaneous implantation of a cardiac occluder, a complex healing process leads to the device coverage within several months. An incomplete device coverage increases the risk of device related complications such as thrombosis or endocarditis. We aimed to assess the device coverage process of atrial septal defect (ASD) occluders in a chronic sheep model using micro-computed tomography (micro-CT). After percutaneous creation of an ASD, 8 ewes were implanted with a 16-mm Nit-Occlud ASD-R occluder (PFM medical, Cologne, Germany) and were followed for 1 month (N = 3) and 3 months (N = 5). After heart explant, the device coverage was assessed using micro-CT (resolution of 41.7 μm) and was compared to histological analysis. The micro-CT image reconstruction was performed in 2D and 3D allowing measurement of the coverage thickness and surface for each device. Macroscopic assessment of devices showed that the coverage was complete for the left-side disk in all cases. Yet incomplete coverage of the right-side disk was observed in 5 of the 8 cases. 2D and 3D micro-CT analysis allowed an accurate evaluation of device coverage of each disk and was overall well correlated to histology sections. Surface calculation from micro-CT images of the 8 cases showed that the median surface of coverage was 93±8% for the left-side disk and 55±31% for the right-side disk. The assessment of tissue reactions, including endothelialisation, after implantation of an ASD occluder can rely on in vitro micro-CT analysis. The translation to clinical practice is challenging but the potential for individual follow-up is shown, to avoid thrombotic or infective complications.
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Affiliation(s)
- Elodie Perdreau
- Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France
- U1045, Centre de recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France
- U1045, INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Zakaria Jalal
- Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France
- U1045, Centre de recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France
- U1045, INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
- Congenital and Pediatric Cardiology Unit, Bordeaux University Hospital, Pessac, France
| | - Richard D Walton
- Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France
- U1045, Centre de recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France
- U1045, INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Matthias Sigler
- Pediatric Cardiology and Intensive Care Medicine, Georg-August University Hospital, Göttingen, Germany
| | - Hubert Cochet
- Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France
- U1045, Centre de recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France
- U1045, INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
- Cardiothoracic Pole, Bordeaux University Hospital, Pessac, France
| | - Jérôme Naulin
- Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France
- U1045, Centre de recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France
- U1045, INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Bruno Quesson
- Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France
- U1045, Centre de recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France
- U1045, INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Olivier Bernus
- Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France
- U1045, Centre de recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France
- U1045, INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Jean-Benoît Thambo
- Electrophysiology and Heart Modeling Institute, IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France
- U1045, Centre de recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France
- U1045, INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
- Congenital and Pediatric Cardiology Unit, Bordeaux University Hospital, Pessac, France
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Kim M, Lee PH, Kim DH, Jung SH, Lee SA, Lee S, Kang DH, Song JK, Song JM. Transcatheter versus surgical closure of atrial septal defect in adult patients with tricuspid regurgitation. Heart 2022; 108:1957-1963. [PMID: 35906027 DOI: 10.1136/heartjnl-2022-321225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/11/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Transcatheter closure using a device has been established as an effective atrial septal defect (ASD) treatment, but its value in treating patients with concomitant functional tricuspid regurgitation (TR) is relatively unknown. We sought to evaluate outcomes of patients with ASD and significant TR after transcatheter ASD closure or surgical treatment. METHODS A total of 252 consecutive adult patients (53.8±13.8 years, 180 females) who had a significant functional TR before ASD closure were retrospectively analysed. The primary end point was a composite of all-cause death, stroke and heart failure. The secondary end point was significant residual TR early and at 1 year after ASD closure. RESULTS Transcatheter ASD closure alone and surgical ASD closure along with tricuspid annuloplasty (TAP) were performed in 68 and 184 patients, respectively. Significant TR remained in 32% (81/252) early after ASD closure and in 29% (52/182) after 1 year. The severity of TR was significantly decreased after transcatheter ASD closure (p<0.001). In multivariable analysis, TAP (OR 0.07; p<0.001) and ASD diameter (OR 0.90; p=0.040) were independent predictors of the significant residual TR early after treatment, while only TAP (OR 0.08; p<0.001) was a significant predictor at 1 year after treatment. After propensity score matching in patients with moderate or severe TR, there were no significant differences between the transcatheter ASD closure group and surgical ASD closure plus TAP group in terms of the event rates at 5 years (10.3% vs 5.5%, p=0.963). CONCLUSIONS While TAP was effective for the treatment of significant TR, transcatheter ASD closure also significantly reduced TR as well. Transcatheter ASD closure may be considered an alternative treatment option in patients with moderate or severe TR.
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Affiliation(s)
- Mijin Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, The Republic of Korea
| | - Pil Hyung Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, The Republic of Korea
| | - Dae-Hee Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, The Republic of Korea
| | - Sung-Ho Jung
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, The Republic of Korea
| | - Seung-Ah Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, The Republic of Korea
| | - Sahmin Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, The Republic of Korea
| | - Duk-Hyun Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, The Republic of Korea
| | - Jae-Kwan Song
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, The Republic of Korea
| | - Jong-Min Song
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, The Republic of Korea
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Kim AY, Woo W, Lim BJ, Jung JW, Young Choi J, Kim YJ. Assessment of Device Neoendothelialization With Cardiac Computed Tomography Angiography After Transcatheter Closure of Atrial Septal Defect. Circ Cardiovasc Imaging 2022; 15:e014138. [PMID: 35861980 PMCID: PMC9298151 DOI: 10.1161/circimaging.122.014138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although the transcatheter closure of atrial septal defect was established as the treatment of choice several decades ago, the process of device neoendothelialization (NE) in humans is not well understood. We aimed to measure the extent of device NE using cardiac computed tomography angiography and analyze its risk factors.
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Affiliation(s)
- Ah Young Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Hospital (A.Y.K., J.W.J., J.Y.C.), Yonsei University College of Medicine, Seoul, Korea
| | - Wongi Woo
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital (W.W.), Yonsei University College of Medicine, Seoul, Korea
| | - Beom Jin Lim
- Department of Pathology, Gangnam Severance Hospital (B.J.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Jo Won Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Hospital (A.Y.K., J.W.J., J.Y.C.), Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Hospital (A.Y.K., J.W.J., J.Y.C.), Yonsei University College of Medicine, Seoul, Korea
| | - Young Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital (Y.J.K)
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Pre-clinical Evolution of a Novel Transcatheter Bioabsorbable ASD/PFO Occluder Device. Pediatr Cardiol 2022; 43:986-994. [PMID: 34981140 DOI: 10.1007/s00246-021-02809-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
To date, there has been limited investigation of bioabsorbable atrial septal defect (ASD) or patent foramen ovale (PFO) closure devices using clinically relevant large animal models. The purpose of this study is to explore the function and safety of a bioabsorbable ASD occluder (BAO) system for PFO and/or secundum ASD transcatheter closure. Using a sheep model, the intra-atrial septum was evaluated by intracardiac echo (ICE). If a PFO was not present, atrial communication was created via transseptal puncture. Device implantation across the intra-atrial communication was performed with fluoroscopic and ICE guidance. Our 1st generation device consisted of a main structure of thin Poly(L-lactide-co-epsilon-caprolactone) (PLCL) fibers, and an internal Poly glycolic acid (PGA) fabric. Four procedures validated procedure feasibility. Subsequently, device design was modified for improved transcatheter delivery. The 2nd generation device has a two-layered structure and was implanted in six sheep. Results showed procedural success in 9/10 (90%) animals. With deployment, the 1st generation device did not reform into its original disk shape and did not conform nicely along the atrial septum. The 2nd generation device was implanted in six animals, 3 out of 6 survived out to 1 year. At 1 year post implantation, ICE confirmed no residual shunting. By necropsy, biomaterials had partially degraded, and histology of explanted samples revealed significant device endothelialization and biomaterial replacement with a collagen layer. Our results demonstrate that our modified 2nd generation BAO can be deployed via minimally invasive percutaneous transcatheter techniques. The BAO partially degrades over 1 year and is replaced by host native tissues. Future studies are needed prior to clinical trials.
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Effectiveness and Safety of Transcatheter Atrial Septal Defect Closure in Adults with Systemic Essential Hypertension. J Clin Med 2022; 11:jcm11040973. [PMID: 35207245 PMCID: PMC8879914 DOI: 10.3390/jcm11040973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 02/10/2022] [Indexed: 12/27/2022] Open
Abstract
Concomitant systemic essential hypertension (HTN) in adults with a secundum atrial septal defect (ASD) can unfavorably affect the hemodynamics and transcatheter ASD closure (ASDC) effects. This study aims to assess the effectiveness and safety of ASDC in adults with HTN in real-world clinical practice. Right ventricular (RV) reverse remodeling (RVR) and the lack of a left-to-right interatrial residual shunt (NoRS) in echocardiography 24 h and 6 months (6 M) post-ASDC, and ASDC-related complications within 6 M were evaluated in 184 adults: 79 with HTN (HTN+) and 105 without HTN (HTN−). Compared to HTN−, HTN+ patients were older and had a greater RV size and the prevalence of atrial arrhythmias, chronic heart failure, nonobstructive coronary artery disease, diabetes, hyperlipidemia, and left ventricular diastolic dysfunction. ASDC was successful and resulted in RVR, NoRS, and a lack of ASDC-related complications in the majority of HTN+ patients both at 24 h and 6 M. HTN+ and HTN− did not differ in ASD size, a successful implantation rate (98.7% vs. 99%), RVR 24 h (46.8% vs. 46.7%) and 6 M (59.4% vs. 67.9%) post-ASDC, NoRS 24 h (79% vs. 81.5%) and 6 M (76.6% vs. 86.9%) post-ASDC, and the composite of RVR and NoRS at 6 M (43.8% vs. 57.1%). Most ASDC-related complications in HTN+ occurred within 24 h and were minor; however, major complications such as device embolization within 24 h and mitral regurgitation within 6 M were observed. No differences between HTN+ and HTN− were observed in the total (12.7% vs. 9.5%) and major (5.1% vs. 4.8%) complications. Transcatheter ASDC is effective and safe in adults with secundum ASD and concomitant HTN in real-world clinical practice; however, proper preprocedural management and regular long-term follow-up post-ASDC are required.
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Guo X, Han X, Li T, Liu G. Perclose ProGlide devices simplified the removal of the femoral venous cannulas for the transcatheter closure of atrial septal defect: A single-center retrospective study. VASCULAR INVESTIGATION AND THERAPY 2022. [DOI: 10.4103/2589-9686.348221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Transcatheter versus surgical closure of atrial septal defects: a systematic review and meta-analysis of clinical outcomes. Cardiol Young 2022; 32:1-9. [PMID: 34819196 DOI: 10.1017/s1047951121004583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Atrial septal defects are a common form of CHD and dependent on the size and nature of atrial septal defects, closure may be warranted. The paper aims to compare outcomes of transcatheter versus surgical repair of atrial septal defects. METHODS A comprehensive electronic literature search was conducted. Primary studies were included if they compared both closure techniques. Primary outcomes included procedural success, mortality, and reintervention rate. Secondary outcomes included residual defect and mean hospital stay. RESULTS A total of 33 studies were included in meta-analysis. Mean total hospital stay was significantly shorter in the transcatheter cohort across both the adult (95% confidence interval, mean difference -4.05 (-4.78, -3.32) p < 0.00001) and paediatric populations (95% confidence interval, mean difference -4.78 (-5.97, -3.60) p < 0.00001). There were significantly fewer complications in the transcatheter group across both the adult (odds ratio 0.45, 95% confidence interval, [0.28, 0.72], p < 0.00001) and paediatric cohorts (odds ratio 0.26, 95% confidence interval, [0.14, 0.49], p < 0.00001). No significant difference in overall mortality was found between transcatheter versus surgical closure across the two groups, adult (odds ratio 0.76, 95% confidence interval, [0.40, 1.45], p = 0.41), paediatrics (odds ratio 0.62, 95% confidence interval, [0.21, 1.83], p = 0.39). CONCLUSION Both transcatheter and surgical approaches are safe and effective techniques for atrial septal defect closure. Our study has demonstrated the benefits of transcatheter closure in terms of lower complication rates and mean hospital stay. However, surgery still has a place for more complex closure and, as we have demonstrated, shows no difference in mortality.
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Akseer S, Abrahamyan L, Lee DS, Huszti E, Meier LM, Osten M, Benson L, Horlick E. Long-Term Outcomes in Adult Patients With Pulmonary Hypertension After Percutaneous Closure of Atrial Septal Defects. Circ Cardiovasc Interv 2021; 15:e011110. [PMID: 34911355 DOI: 10.1161/circinterventions.121.011110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH), recently redefined as mean pulmonary arterial pressure >20 mm Hg (PH20), may be observed in patients with atrial septal defects (ASD). We aimed to determine the effect of preprocedural PH20 status on outcomes among patients undergoing ASD closure. METHODS Study population was selected from a retrospective registry of adult patients who underwent percutaneous ASD closure from 1998 to 2016 from a single center and had right heart catheterizations during the procedure. The clinical registry was linked to administrative databases to capture short- and long-term outcomes. RESULTS We included a total of 632 ASD closure patients of whom 359 (56.8%) had PH20. The mean follow-up length was 7.6±4.6 years. Patients with PH20 were older (mean age 56.5 versus 43.1 years, P<0.001) and a higher prevalence of comorbidities including hypertension (54.3% versus 21.6%, P<0.001) and diabetes (18.1% versus 5.9%, P<0.001) than those without PH. In a Cox proportional hazards model after covariate adjustment, patients with PH had a significantly higher risk of developing major adverse cardiac and cerebrovascular events (heart failure, stroke, myocardial infarction, or cardiovascular mortality), with hazards ratio 2.45 (95% CI, 1.4-4.4). When applying the prior, mean pulmonary arterial pressure ≥25 mm Hg (PH25) cutoff, a significantly higher hazard of developing major adverse cardiac and cerebrovascular events was observed in PH versus non-PH patients. CONCLUSIONS ASD patients with PH undergoing closure suffer from more comorbidities and worse long-term major adverse cardiac and cerebrovascular events outcomes, compared with patients without PH. The use of the new PH20 definition potentially dilutes the effect of this serious condition on outcomes in this population.
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Affiliation(s)
- Selai Akseer
- Toronto General Hospital Research Institute, University Health Network (UHN), Ontario, Canada (S.A., L.A., D.S.L., E.H.).,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Ontario, Canada. (S.A., L.A., D.S.L., E.H.)
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network (UHN), Ontario, Canada (S.A., L.A., D.S.L., E.H.).,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Ontario, Canada. (S.A., L.A., D.S.L., E.H.)
| | - Douglas S Lee
- Toronto General Hospital Research Institute, University Health Network (UHN), Ontario, Canada (S.A., L.A., D.S.L., E.H.).,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Ontario, Canada. (S.A., L.A., D.S.L., E.H.).,ICES, Toronto, Ontario, Canada (D.S.L.)
| | - Ella Huszti
- Toronto General Hospital Research Institute, University Health Network (UHN), Ontario, Canada (S.A., L.A., D.S.L., E.H.).,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Ontario, Canada. (S.A., L.A., D.S.L., E.H.).,Biostatistics Research Unit, UHN, Toronto, Ontario, Canada (E.H.)
| | - Lukas M Meier
- Adult Congenital Heart Disease Program, University Heart Center, University Hospital Zurich, University of Zurich, Switzerland (L.M.M.)
| | - Mark Osten
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, UHN, Toronto, Ontario, Canada (M.O., E.H.)
| | - Lee Benson
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Ontario, Canada. (L.B.).,Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada (L.B.)
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, UHN, Toronto, Ontario, Canada (M.O., E.H.)
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Yamamoto H, Shinke T, Otake H, Terashita D, Nagasawa A, Tanimura K, Matsumoto K, Tanaka H, Hirata KI. Hemodynamic changes during transcatheter atrial septal defect closure predict midterm heart failure deterioration in adults. Catheter Cardiovasc Interv 2021; 98:E715-E723. [PMID: 34227726 DOI: 10.1002/ccd.29859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/20/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To investigate whether hemodynamic changes during balloon occlusion test (BOT) predict future heart failure (HF) deterioration after transcatheter atrial septal defect closure (tASD-closure). BACKGROUND Midterm HF deterioration can sometimes occur after tASD-closure in adults. Whether hemodynamic changes during tASD-closure can help identify patients at risk is unknown. METHODS This prospective observational study enrolled 86 consecutive adult patients who underwent tASD-closure. Hemodynamic parameters, including pulmonary capillary wedge pressure (PCWP), were measured at baseline, during BOT, and after tASD-closure. The changes in PCWP during BOT and after tASD-closure were defined as ΔPCWP (Occ-Pre) and ΔPCWP (Post-Pre), respectively. Clinical parameters were evaluated before tASD-closure and during the 3-month follow-up. We assessed the occurrence of HF deterioration (HF requiring hospitalization or additional diuretics) during a 2-year follow-up period and categorized patients into HF (+) and HF (-) groups accordingly. The aforementioned parameters were compared between groups. RESULTS Midterm HF deterioration occurred in 12 patients (13.9%). Compared to the HF (-) group, the HF (+) group presented a significantly higher ΔPCWP (Occ-Pre) (9.5 ± 4.4 mmHg vs. 3.0 ± 3.3 mmHg; p < 0.001) and ΔPCWP (Post-Pre) (4.0 ± 2.8 mmHg vs. 0.6 ± 1.8 mmHg; p = 0.004). Receiver operating characteristic curve analysis showed that the ΔPCWP (Occ-Pre) cutoff value of 5.5 mmHg had excellent ability to predict HF deterioration (Area under the curve 0.886 [0.779-0.993], p < 0.001; sensitivity 0.917, specificity 0.824). CONCLUSIONS Increases in PCWP during BOT predict midterm HF deterioration after tASD-closure. Close surveillance may be needed in patients with a ΔPCWP (Occ-Pre) >5 mmHg.
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Affiliation(s)
- Hiroyuki Yamamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Terashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akira Nagasawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kousuke Tanimura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kensuke Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Naser N, Hadziomerovic N, Avdic S. Transcatheter Device Closure of Secundum Atrial Septal Defect in Adult Patient. Acta Inform Med 2021; 29:65-68. [PMID: 34012216 PMCID: PMC8116089 DOI: 10.5455/aim.2021.29.65-70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Atrial septal abnormalities are common congenital lesions remaining asymptomatic until adulthood in a great number of patients. The most frequent atrial septal defects in adults are ostium secundum atrial septal defect (ASD). Complications from untreated, hemodynamically significant ASD are atrial arrhythmia, paradoxical embolization, Eisenmenger’s syndrome, pulmonary hypertension, and right ventricular failure. Objective: We present a case report of secundum ASD in adult female patient who underwent transcatheter device closure with Amplatzer occluder. Methods and Results: The case of female Bosnian patient 50 years old who lives in Belgium for 20 years ago and during her visit to Bosnia she came to our polyclinic for cardiological exam. Echocardiographic exam showed enlargement of left atrium (LAD 51mm), right atrium and ventricle (RAD 46mm, RVd 33mm), atrial septal defect 9mm with left right shunt Qp:Qs 2,3:1. Several months later transcatheter device closure with Amplatzer occluder was performed and subsequent symptomatic improvement reported after closure. Conclusion: Echocardiography has superior role for precise evaluation of ASD type secundum who are suitable for transcatheter device closure as primary treatment option. Transcatheter techniques has now become preferable to surgical repair and provide valid option of treatment for this type of CHD.
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Affiliation(s)
- Nabil Naser
- Polyclinic "Dr. Nabil", Sarajevo, Bosnia and Herzegovina
| | | | - Sevleta Avdic
- Medical Institute Bayer, Tuzla, Bosnia and Herzegovina
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Takaya Y, Akagi T, Nakagawa K, Nakayama R, Miki T, Toh N, Ito H. Feasibility of transcatheter closure for absent aortic rim in patients with atrial septal defect. Catheter Cardiovasc Interv 2021; 97:859-864. [PMID: 33458916 DOI: 10.1002/ccd.29457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/15/2020] [Accepted: 12/24/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study aimed to assess the feasibility of transcatheter atrial septal defect (ASD) closure in patients with absent aortic rim. BACKGROUND The indication of transcatheter closure for ASD with absent aortic rim is controversial. METHODS We enrolled 547 patients with ASD who were scheduled for transcatheter closure. Morphologies of aortic rim were evaluated using transesophageal echocardiography (TEE). RESULTS Aortic rim of <5 mm was observed in 396 (72%) patients; 128 (23%) had absent aortic rim of 0 mm, and 268 (49%) had deficient aortic rim of >0 to <5 mm. Patients with absent aortic rim frequently had aortic rim absence at an angle of 0° on TEE and septal malalignment. Of the 128 patients with absent aortic rim, 126 (98%) successfully underwent transcatheter closure, while 2 (2%) failed transcatheter closure due to a large defect with severe septal malalignment. The success rate of transcatheter closure was similar between patients with absent aortic rim and those with deficient aortic rim (98% vs. 99%, p = .45). After the procedure, no patients had erosion or device embolization during a median follow-up of 24 months. CONCLUSIONS Transcatheter closure was successfully performed without adverse events in patients with absent aortic rim, as well as in those with deficient aortic rim. Our findings can be valuable to determine the indication of transcatheter closure in patients with ASD.
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Affiliation(s)
- Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
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Secundum atrial septal defects transcatheter closure versus surgery in adulthood: a 2000-2020 systematic review and meta-analysis of intrahospital outcomes. Cardiol Young 2021; 31:541-546. [PMID: 33827735 DOI: 10.1017/s1047951121001232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Rajab TK, Kavarana MN. Commentary: Less-invasive atrial septal defect closure can become more invasive. JTCVS Tech 2021; 7:244. [PMID: 34318262 PMCID: PMC8311822 DOI: 10.1016/j.xjtc.2021.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
| | - Minoo N. Kavarana
- Address for reprints: Minoo N. Kavarana, MD, Section of Pediatric Cardiothoracic Surgery, 10 McClennan Banks Dr, Charleston, SC 29425.
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Shin SH. Percutaneous Device Closure of Atrial Septal Defect: Neglected Long-Term Effects on the Left Atrium. J Cardiovasc Imaging 2021; 29:133-134. [PMID: 33605103 PMCID: PMC8099575 DOI: 10.4250/jcvi.2020.0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sung Hee Shin
- Division of Cardiology, Inha University College of Medicine, Incheon, Korea.
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Tuan HX, Long PTP, Kien VD, Kramer H, Dalla-Pozza R. Cost comparison of transcatheter and operative closures for patients with secundum atrial septal defects in Vietnam. Heliyon 2021; 7:e05904. [PMID: 33490673 PMCID: PMC7809180 DOI: 10.1016/j.heliyon.2021.e05904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/09/2020] [Accepted: 01/04/2021] [Indexed: 11/26/2022] Open
Abstract
We aim to estimate and compare the costs of operative and transcatheter closure for patients with secundum atrial septal defect (ASD) in Vietnam. This was a retrospective cross-sectional study based on medical records of congenital heart diseases (CHD) patients in Da Nang Hospital, Vietnam from 2010 through 2015. All costs in this study were calculated according to a provider's perspective. All pricing data were converted into USD at the 2015 exchange rate. A total of 258 patients with secundum ASD were recruited in the study, including 35 patients treated by operative closure and 223 patients treated by transcatheter closure. The total treatment costs of the transcatheter closure group (US $3,107.9) were higher than those of the operative closure group (US $2,080.5). The cost of the procedure and medical supplies accounted for 67.3% of the total treatment cost in the operative closure group, while the cost of occlusion devices accounted for 62.2% of the total cost in the transcatheter closure group. Given the advantages of the transcatheter closure procedure, reducing occlusion device costs may increase the proportion of patients treated with this technique.
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Affiliation(s)
- Ho Xuan Tuan
- Center for International Health, Ludwig-Maximilians-University, Munich, Germany
- School of Medicine and Pharmacy, The Da Nang University, Da Nang city, Viet Nam
- Corresponding author.
| | - Phan The Phuoc Long
- School of Medicine and Pharmacy, The Da Nang University, Da Nang city, Viet Nam
| | - Vu Duy Kien
- OnCare Medical Technology Company Limited, Ha Noi, Viet Nam
| | - Harald Kramer
- Institute of Clinical Radiology, University Hospital of Munich, Germany
| | - Robert Dalla-Pozza
- Center for International Health, Ludwig-Maximilians-University, Munich, Germany
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Großhadern Clinic, Ludwig Maximilians University, Munich, Germany
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Panakkal B, Gaidhane P, Prajapati J, Patel I, Bhutada B, Yadav C, Yadav K. Clinical profile of patients of ASD device closure with special reference to short and intermediate term complications. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.4103/jpcs.jpcs_30_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Takaya Y, Akagi T, Nakagawa K, Nakayama R, Miki T, Toh N, Ito H. Morphological assessments of deficient posterior-inferior rim for transcatheter closure of atrial septal defect. Catheter Cardiovasc Interv 2021; 97:135-141. [PMID: 32790128 DOI: 10.1002/ccd.29182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/26/2020] [Accepted: 07/19/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aimed to determine morphological characteristics of deficient posterior-inferior rim for transcatheter atrial septal defect (ASD) closure success. BACKGROUND The feasibility of transcatheter closure of ASD with deficient posterior-inferior rim remains unclear. METHODS Of 869 patients with ASD who were scheduled transcatheter closure, 121 with posterior-inferior rim of <5 mm were included. Posterior-inferior rim morphologies were evaluated by transesophageal echocardiography. RESULTS One hundred six patients successfully underwent transcatheter closure, while 15 patients failed. These 15 patients had complete deficient posterior-inferior rim of 0 mm and/or a large defect of ≥38 mm. Multivariate logistic regression analysis showed that transcatheter closure failure was independently related to complete deficient posterior-inferior rim and a large defect of ≥38 mm. Incomplete deficient posterior-inferior rim of >0 to <5 mm was observed in 84 patients. All these patients successfully underwent transcatheter closure, except two patients with a large defect of ≥38 mm. Complete deficient posterior-inferior rim was observed in 37 patients. The frequency of complete deficient posterior-inferior rim was higher in patients who failed transcatheter closure (87% vs. 23%, p < .01), but transcatheter closure was performed successfully if the range of complete deficient rim was ≤30°. After the procedure, no adverse events occurred during a median follow-up of 24 months. CONCLUSIONS Most patients with deficient posterior-inferior rim successfully underwent transcatheter closure. Transcatheter closure could be performed even in patients with complete deficient posterior-inferior rim if the range was partial. Our findings can help to identify candidates for transcatheter closure.
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Affiliation(s)
- Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Lahiri R, Gaur N. Mechanophysiologically active patch for closure of atrial septal defect. BMJ Case Rep 2020; 13:13/12/e237785. [PMID: 33298494 DOI: 10.1136/bcr-2020-237785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Closure of atrial septal defects (ASDs) can be achieved by various methods right from direct closure to patch closure using various materials viz. pericardium, Dacron and Teflon, to device closure using percutaneous techniques. Although percutaneous techniques are the most commonly practised method in developed countries, a subset of patients will require surgical closure. Various patch materials have been used for long, but all of them have some complications and risks associated with them. We report a case of novel technique of ASD closure done using a pedicled, vascularised and contractile right atrial wall flap.
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Affiliation(s)
- Raja Lahiri
- CVTS, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Namrata Gaur
- CVTS, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
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Khan MA, Korejo H, Sohail A, Shaikh AS, Patel N. Immediate and Short-Term Outcome of Percutaneous Atrial Septal Defects Closure in Adult Patients. Cureus 2020; 12:e11165. [PMID: 33251072 PMCID: PMC7688064 DOI: 10.7759/cureus.11165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Atrial septal defect secundum (ASD II) is the commonest of the congenital heart diseases in the adult population and the closure of ASD II causes a significant improvement in hemodynamics and the clinical status of the patient. However, it carries certain risks, especially the development of post-closure pulmonary edema and congestive cardiac failure, which may lead to death. Therefore, this study was designed to share our experience and to evaluate the immediate and short-term outcomes of percutaneous closure of ASD II in adult patients presenting at a tertiary care cardiac center in Karachi, Pakistan. Methodology In this study, we included 30 adult (≥ 40 years) patients who underwent percutaneous ASD II closure at the pediatric cardiology department of the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan, between June 1, 2017, and July 31, 2019. Data for this study were extracted from a prospectively collected departmental database. Extracted data for this study consisted of demographic profile, comorbid conditions, echocardiographic findings, cardiac catheterization data, pre and post six-month electrocardiographic findings, and New York Heart Association (NYHA) Functional Classification (FC). Results Out of 30 adult patients, 18 (60%) were female. The mean age of the patients at the time of ASD closure was 51.43 ± 7.09 years, ranging between 40 and 67 years. None of the patients had any post-intervention complications. Mean systolic pulmonary artery pressure (SPAP) on cardiac catheterization pre-implantation was 49.8 ± 16.3 mmHg range was 20-90 mmHg while SPAP immediately after device implantation was 37 ± 11.4 range 20 to 65 mmHg with p<0.001. Mean SPAP on pre-catheterization echocardiography was 58.8 ± 14.3, range 30-95 mmHg, while after six months, the mean SPAP was 34.5 ± 7.2, range 20-45 mmHg, with p<0.001 in 28 (93.3%) patients (in two patients, there was no TR). There was no mortality up till six months after the intervention. The functional class (FC) after six months of the procedure improved in most, 90% (27), of the patients. Conclusion There were no complications immediately after the procedure. After six months, post-procedure SPAP decreased to < 50 mmHg in the majority of patients (96.6%). Functional class (FC) improved in most (90%) of the adult (≥ 40 years) patients undergone percutaneous atrial septal defects closure. Therefore, percutaneous closure of ASD II is a safe and effective procedure for adult patients.
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Miki T, Yamano T, Yamano M, Nakamura T, Takamatsu K, Ma C, Wakana N, Nakanishi N, Zen K, Shiraishi H, Shirayama T, Matoba S. Favorable changes of left ventricular function in the circumferential direction following transcatheter atrial septal defect closure: a strain imaging study. Int J Cardiovasc Imaging 2020; 37:903-912. [PMID: 33047179 DOI: 10.1007/s10554-020-02064-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/05/2020] [Indexed: 11/26/2022]
Abstract
To clarify the impact on left ventricular (LV) function of percutaneous atrial septal defect (ASD) closure in adult patients. Echocardiograms of 46 patients (52 ± 18 years) who underwent ASD closure with a significant left-to-right shunt obtained before and 1 month after the procedure were retrospectively analyzed. Functional parameters were obtained by 2-dimensional speckle-tracking imaging. Global longitudinal strain and strain rate at early diastole (SRe) was calculated from the three standard apical views, while circumferential and radial parameters were calculated from basal, middle, and apical LV short-axis views. Along with a diminished right ventricular (RV) volume, the LV volume and ejection fraction increased (end-diastolic volume: 61 ± 12 to 76 ± 15 mL, p < 0.001; and 63% ± 4 to 64% ± 4% p = 0.03; respectively). Both global strain and SRe was augmented only in the circumferential direction (- 16.2% ± 2.9% to - 19.8% ± 2.8%; and 1.07 ± 0.29 to 1.34 ± 0.28 s-1, both p < 0.001). Augmentation of circumferential SRe correlated with both the changes in and the pre-procedural value of diastolic LV eccentricity index (r = - 0.57, p < 0.001; and r = 0.37, p = 0.01; respectively), a morphological parameter of RV volume overload. Following ASD closure in adults, both LV systolic and diastolic function could favorably change in the circumferential direction, and the degree of diastolic functional change is associated with RV volume overload, i.e., severity of ventricular interdependence.
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Affiliation(s)
- Tomonori Miki
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuaki Takamatsu
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Chao Ma
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Noriyuki Wakana
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Naohiko Nakanishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Shirayama
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
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Clinical Significance of Septal Malalignment for Transcatheter Closure of Atrial Septal Defect. J Interv Cardiol 2020; 2020:6090612. [PMID: 32206044 PMCID: PMC7072101 DOI: 10.1155/2020/6090612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/29/2020] [Indexed: 11/28/2022] Open
Abstract
Background Septal malalignment is related to erosion and device embolization in transcatheter closure of atrial septal defect (ASD), but limited information is available. Objectives This study aimed to assess clinical significance of septal malalignment and to determine appropriate evaluation of ASD diameter, including the selection of device size. Methods Four hundred and seventeen patients with ASD who underwent transcatheter closure were enrolled. Septal malalignment was defined as separation between the septum primum and the septum secundum on transesophageal echocardiography. Results One hundred and eighty-four patients had septal malalignment. The frequency of septal malalignment increased with age reaching around 50% in adult patients. Septal malalignment was related to aortic rim deficiency. The distance of separation between the septum primum and the septum secundum was 5 ± 2 mm (range, 1–11 mm). In patients with septal malalignment, the ASD diameter measured at the septum primum was 19 ± 6 mm, while the ASD diameter measured at the septum secundum was 16 ± 6 mm. There was a difference of 4 ± 2 mm (range, 0–8 mm) between the ASD diameter measured at the septum primum and that measured at the septum secundum. For transcatheter closure, the Amplatzer Septal Occluder device size 2-3 mm larger and the Occlutech Figulla Flex II device size 4–7 mm larger than the ASD diameter measured at the septum primum were frequently used. During the study period, erosion or device embolization did not occur in all of the patients. Conclusions Septal malalignment is highly prevalent in adult patients with aortic rim deficiency. The measurement of ASD diameter at the septum primum can be valuable for the selection of device size in patients with septal malalignment.
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Appropriate selection of echocardiographic guidance for transcatheter atrial septal defect closure. Int J Cardiovasc Imaging 2020; 36:855-863. [DOI: 10.1007/s10554-020-01778-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/24/2020] [Indexed: 01/26/2023]
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Yamano M, Yamano T, Nakamura T, Zen K, Shiraishi H, Shirayama T, Matoba S. Predictors of Increased Left Ventricular Filling Pressure After Transcatheter Atrial Septal Defect Closure. Circ Rep 2020; 2:113-120. [PMID: 33693216 PMCID: PMC7929757 DOI: 10.1253/circrep.cr-19-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background:
The aim of this study was to identify factors of left ventricular filling pressure (LVFP) elevation following transcatheter atrial septal defect (ASD) closure. Methods and Results:
The study involved 97 adult patients with sinus rhythm who underwent both transcatheter ASD closure and transthoracic echocardiography. Elevated LVFP was diagnosed during the first month of follow-up according to the American Society of Echocardiography guidelines: that is, ratio of transmitral early filling to the lateral annular diastolic velocity (lateral E/e’) >13 was used to exclude the effect of the device on the atrial septum. Fifteen patients (15.5%) were diagnosed with increased LVFP during the 1-month follow-up period (median lateral E/e’: from 9.2, IQR, 6.6–10.8; to 15.5, IQR, 13.8–17.8; P<0.001). Independent predictors of LVFP elevation were left ventricular (LV) relative wall thickness, lateral E/e›, and peak tricuspid regurgitation pressure gradient (TRPG) at baseline (OR, 1.67; 95% CI: 1.04–2.69; OR, 1.52; 95% CI: 1.07–2.15; and OR, 1.14; 95% CI: 1.04–1.25; cut-offs: 0.42, 7.5, and 27.0 mmHg, respectively). Median lateral E/e› returned to baseline in most patients with LVFP elevation during 6 months of subsequent follow-up (1-month–6-month follow-up: 15.5, IQR, 13.8–17.8; 11.1, IQR, 8.8–14.8, respectively; P=0.001). Conclusions:
The increase in Doppler-estimated LVFP following transcatheter ASD closure may be related to LV hypertrophy, diastolic dysfunction, and peak TRPG in elderly patients.
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Affiliation(s)
- Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
| | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
| | - Takeshi Shirayama
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
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Yi K, Guo X, You T, Wang Y, Ding F, Hou X, Zhou L. Standard median sternotomy, right minithoracotomy, totally thoracoscopic surgery, percutaneous closure, and transthoracic closure for atrial septal defects in children: A protocol for a network meta-analysis. Medicine (Baltimore) 2019; 98:e17270. [PMID: 31568005 PMCID: PMC6756700 DOI: 10.1097/md.0000000000017270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 08/28/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Atrial septal defect (ASD) is one of the most common congenital heart diseases, with an average of 1.64 per 1000 newborns with the ASD. Empirical studies suggest that surgery should be performed early in the presence of right atrium and or right ventricular enlargement, even for asymptomatic patients. Many surgical procedures can be used to treat ASD. But which method is the best choice remains unclear. This study aims to compare the efficacy and safety of standard median sternotomy, right minithoracotomy, totally thoracoscopic surgery, percutaneous closure, transcutaneous by echocardiography, and transcutaneous by radiotherapy for ASDs in children using Bayesian network meta-analysis (NMA). METHODS We will perform a comprehensive literature search using PubMed, EMBASE.com, the Cochrane Library, Web of Science, and Chinese Biomedical Literature Database to identify relevant studies from inception to April 2019. Randomized controlled trials, prospective or retrospective cohort studies that reported the efficacy and safety of surgical procedures for the treatment of atrial septal defects will be included. Risk of bias of the included randomized controlled trials and prospective or retrospective cohort studies will be evaluated according to the Cochrane Handbook 5.1.0 and the risk of bias in non-randomized studies of interventions, respectively. A Bayesian NMA will be performed using R 3.4.1. RESULTS The results of this NMA will be submitted to a peer-reviewed journal for publication. CONCLUSION This NMA will summarize the direct and indirect evidence to assess the efficacy and safety of different surgical procedures for the treatment of ASDs. ETHICS AND DISSEMINATION Ethics approval and patient consent are not required as this study is a network meta-analysis based on published trials. PROSPERO REGISTRATION NUMBER CRD42019130902.
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Affiliation(s)
- Kang Yi
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- International Congenital Heart Disease Diagnosis and Treatment Reginal Center
| | - Xujian Guo
- The First Clinical Medical College of Lanzhou University
| | - Tao You
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- International Congenital Heart Disease Diagnosis and Treatment Reginal Center
| | - Yunfang Wang
- Department of Endocrinology, Gansu Provincial Hospital
| | - Fan Ding
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- International Congenital Heart Disease Diagnosis and Treatment Reginal Center
| | - Xiaodong Hou
- Department of Cardiovascular Surgery, Gansu Provincial Hospital
- International Congenital Heart Disease Diagnosis and Treatment Reginal Center
| | - Li Zhou
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
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Oster M, Bhatt AB, Zaragoza-Macias E, Dendukuri N, Marelli A. Interventional Therapy Versus Medical Therapy for Secundum Atrial Septal Defect: A Systematic Review (Part 2) for the 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease. J Am Coll Cardiol 2019; 73:1579-1595. [DOI: 10.1016/j.jacc.2018.08.1032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Cohen S, Jannot AS, Iserin L, Bonnet D, Burgun A, Escudié JB. Accuracy of claim data in the identification and classification of adults with congenital heart diseases in electronic medical records. Arch Cardiovasc Dis 2019; 112:31-43. [PMID: 30612895 DOI: 10.1016/j.acvd.2018.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/23/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The content of electronic medical records (EMRs) encompasses both structured data, such as billing codes, and unstructured data, including free-text reports. Epidemiological and clinical research into adult congenital heart disease (ACHD) increasingly relies on administrative claim data using the International Classification of Diseases (9th revision) (ICD-9). In France, administrative databases use ICD-10, the reliability of which is largely unknown in this context. AIMS To assess the accuracy of ICD-10 codes retrieved from administrative claim data in the identification and classification of ACHD. METHODS We randomly included 6000 patients hospitalized at least once in 2000-2014 in a cardiology department with a dedicated specialized ACHD Unit. For each patient, the clinical diagnosis extracted from the EMR was compared with the assigned ICD-10 codes. Performance of ICD-10 codes in the identification and classification of ACHD was assessed by estimating sensitivity, specificity and positive predictive value. RESULTS Among the 6000 patients included, 780 (13%) patients with ACHD were manually identified from EMRs (107,092 documents). ICD-10 codes correctly categorized 629 as having ACHD (sensitivity 0.81, 95% confidence interval 0.78-0.83), with a specificity of 0.99 (95% confidence interval 0.99-1). The performance of ICD-10 codes in correctly categorizing the ACHD defect subtype depended on the defect, with sensitivity ranging from 0 (e.g. unspecified congenital malformation of tricuspid valve) to 1 (e.g. common arterial trunk), and specificity ranging from 0.99 to 1. CONCLUSIONS Administrative data using ICD-10 codes is a precise tool for detecting ACHD, and may be used to establish a national cohort. Mining free-text reports in addition to coded administrative data may offset the lack of sensitivity and accuracy when describing the spectrum of congenital heart disease using ICD-10 codes.
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Affiliation(s)
- Sarah Cohen
- Inserm-UMRS 1138, Team 22, Cordeliers Research Centre, Paris Descartes University, 15, rue de l'École de Médecine, 75006 Paris, France.
| | - Anne-Sophie Jannot
- Inserm-UMRS 1138, Team 22, Cordeliers Research Centre, Paris Descartes University, 15, rue de l'École de Médecine, 75006 Paris, France; Department of Medical Informatics and Public Health, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Laurence Iserin
- Adult Congenital Heart Disease Unit, Cardiology Department, M3C, Reference Centre for Complex Congenital Heart Diseases, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Damien Bonnet
- Department of Paediatric Cardiology, M3C, Reference Centre for Complex Congenital Heart Diseases, hôpital Necker-Enfants-Malades, AP-HP, 75015 Paris, France; Paris Descartes University Sorbonne Paris Cité, 75006 Paris, France
| | - Anita Burgun
- Inserm-UMRS 1138, Team 22, Cordeliers Research Centre, Paris Descartes University, 15, rue de l'École de Médecine, 75006 Paris, France; Department of Medical Informatics and Public Health, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Jean-Baptiste Escudié
- Inserm-UMRS 1138, Team 22, Cordeliers Research Centre, Paris Descartes University, 15, rue de l'École de Médecine, 75006 Paris, France; Department of Medical Informatics and Public Health, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
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Askari B, Soraya H, Ayremlu N, Golmohammadi M. Short-term outcomes after surgical versus trans catheter closure of atrial septal defects; a study from Iran. Egypt Heart J 2018; 70:249-253. [PMID: 30591738 PMCID: PMC6303347 DOI: 10.1016/j.ehj.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/02/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Atrial Septal Defect (ASD) accounts for 10% of congenital cardiac defects. The purpose of this retrospective study was to compare the short-term outcomes of surgical versus trans catheter closure of secundum atrial septal defect. METHODS This is a single-center retrospective cohort study in patients who had surgical or trans catheter ASD closure. ASD closure outcomes such as hospital cost, length of hospital and ICU stay, residual ASDs, complications, readmission, hospital and three month mortality were recorded and compared. RESULTS Between March 2010 and March 2016, total of 102 secundum ASD patients were treated in our center (71 patients surgical ASD closure and 31 patients trans catheter ASD closure). About 13.9% of patients (5/36) in the device group had failed procedural attempt for various reasons and these patients underwent surgery closure. Complete closure was observed in 26 of 31 patients (83.9%) in the device group and in 70 of 71 patients in the surgery group (98.6%). The mean length of hospital stay was 5.56 days for surgical group and 2.06 days for device group. The procedure cost for surgery was found to be 5.7% lower than trans catheter closure (patient payment). The complication rates were 18.3% for surgical group and 25.8% for the device group. Readmission after discharge was more common in surgery group (11.2 vs 6.4%). Hospital and three months mortality in both groups were zero. CONCLUSIONS Both trans catheter and surgical procedure are good methods of successful ASD closure. Considering that the surgical group patients were higher risk patients, mean total hospital cost of patient's procedures were significantly higher in device closure group, failed intervention rate and residual ASD were more common in device group and complications of device group were more serious; thus, appropriate patient selection is an important factor for successful device closure.
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Affiliation(s)
- Behnam Askari
- Department of Cardiovascular Surgery, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamid Soraya
- Department of Pharmacology, Faculty of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
| | - Nasim Ayremlu
- Department of Cardiovascular Surgery, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Mitra Golmohammadi
- Department of Cardiac Anesthesiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
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Konagai N, Fukui S, Kitano M, Asaumi Y, Nakanishi M, Ogo T, Fujita T, Ohnishi Y, Kobayashi J, Yasuda S. Successful Transcatheter Atrial Septal Defect Closure Prior to Coronary Artery Bypass Grafting Using Anti-Congestive Therapies and Intraaortic Balloon Pumping in a Patient with Severe Ischemic Cardiomyopathy and Triple-Vessel Coronary Artery Disease. Int Heart J 2018; 59:1480-1484. [DOI: 10.1536/ihj.17-563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Nao Konagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Kumamoto University Graduate School of Medical Sciences
| | - Shigefumi Fukui
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masataka Kitano
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Michio Nakanishi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takeshi Ogo
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center
| | - Junjiro Kobayashi
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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O'Byrne ML, Levi DS. State-of-the-Art Atrial Septal Defect Closure Devices for Congenital Heart. Interv Cardiol Clin 2018; 8:11-21. [PMID: 30449418 DOI: 10.1016/j.iccl.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article describes current devices and indications for transcatheter device closure of atrial septal defect (TC-ASD) and patent foramen ovale in children and young adults. TC-ASD has a proven record of efficacy and safety, but device erosion raises questions about the relative safety of TC-ASD versus operative open heart surgical ASD closure. New devices for ASD closure with properties to reduce risk of erosion are being developed. Recent studies demonstrating superiority of patent foramen ovale device closure over medical therapy for cryptogenic stroke may lead to changes in practice for structural/interventional cardiologists. Care should be taken in extrapolating data to children and younger adults.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Center for Pediatric Clinical Effectiveness, Leonard Davis Institute, University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Daniel S Levi
- Division of Cardiology, UCLA Mattel Children's Hospital, University of California Los Angeles Medical School, 200 UCLA Medical Plaza #330, Los Angeles, CA 90095, USA
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Alnasser S, Lee D, Austin PC, Labos C, Osten M, Lightfoot DT, Kutty S, Shah A, Meier L, Benson L, Horlick E. Long term outcomes among adults post transcatheter atrial septal defect closure: Systematic review and meta-analysis. Int J Cardiol 2018; 270:126-132. [DOI: 10.1016/j.ijcard.2018.06.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/22/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
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Ok T, La YK, Cha HS, Cheon K, Choi BK, Yi GJ, Lee KY. Stroke Recurrence in a Patient Twelve Years after Repair of a Secundum Atrial Septal Defect. JOURNAL OF NEUROCRITICAL CARE 2018. [DOI: 10.18700/jnc.180037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Abstract
The need for population-based studies of adults with CHD has motivated the growing use of secondary analyses of administrative health data in a variety of jurisdictions worldwide. We aimed at systematically reviewing all studies using administrative health data sources for adult CHD research from 2006 to 2016. Using PubMed and Embase (1 January, 2006 to 1 January, 2016), we identified 2217 abstracts, from which 59 studies were included in this review. These comprised 12 different data sources from six countries. Of these, 55% originated in the United States of America, 28% in Canada, and 17% in Europe and Asia. No study was published before 2007, after which the number of publications grew exponentially. In all, 41% of the studies were cross-sectional and 25% were retrospective cohort studies with a wide variation in the availability of patient-level compared with hospitalisation-level episodes of care; 58% of studies from eight different data sources linked administrative data at a patient level; and 37% of studies reported validation procedures. Assessing resource utilisation and temporal trends of relevant epidemiological and outcome end points were the most reported objectives. The median impact factor of publication journals was 4.04, with an interquartile range of 3.15, 7.44. Although not designed for research purposes, administrative health databases have become powerful data sources for studying adult CHD populations because of their large sample sizes, comprehensive records, and long observation periods, providing a useful tool to further develop quality of care improvement programmes. Data linkage with electronic records will become important in obtaining more granular life-long adult CHD data. The health services nature of the data optimises the impact on policy and public health.
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O’Byrne ML, Glatz AC, Gillespie MJ. Transcatheter device closure of atrial septal defects: more to think about than just closing the hole. Curr Opin Cardiol 2018; 33:108-116. [PMID: 29076870 PMCID: PMC6112166 DOI: 10.1097/hco.0000000000000476] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review current controversies in the transcatheter device closure of ostium secundum atrial septal defects (ASD). RECENT FINDINGS Transcatheter device closure of ASD (TC-ASD) has well established efficacy and safety. For most individual patients with suitable anatomy, TC-ASD is the preferred method for treating ASD. The availability of large multicenter data sets has made it possible to study practice patterns at a range of hospitals across the United States. These studies have revealed differences in practice that were not previously appreciated. Interpretation of the indications for TC-ASD, specifically the definition of right ventricular volume overload varies between hospitals. In response to concern about device erosion, an increasing proportion of patients are being referred for operative ASD closure. Over the last decade, the average age at which ASD closure occurs has decreased. These trends demonstrate previously underappreciated differences in opinion between cardiologists across the country and suggest that further research is necessary to address knowledge gaps limiting consistency of practice. SUMMARY As TC-ASD and congenital interventional cardiology mature as a field, studies of real-world practice provide increasingly valuable information about aspects of care in which there are disagreements about best practices and in which further research is necessary.
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Affiliation(s)
- Michael L O’Byrne
- Division of Cardiology The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Philadelphia PA
- Center for Pediatric Clinical Effectiveness and Cardiac Center Research Core, The Children’s Hospital of Philadelphia, Philadelphia PA
- Leonard Davis Institute, University of Pennsylvania, Philadelphia PA
| | - Andrew C Glatz
- Division of Cardiology The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Philadelphia PA
- Center for Pediatric Clinical Effectiveness and Cardiac Center Research Core, The Children’s Hospital of Philadelphia, Philadelphia PA
| | - Matthew J Gillespie
- Division of Cardiology The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Philadelphia PA
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Takaya Y, Akagi T, Kijima Y, Nakagawa K, Ito H. Functional Tricuspid Regurgitation After Transcatheter Closure of Atrial Septal Defect in Adult Patients. JACC Cardiovasc Interv 2017; 10:2211-2218. [DOI: 10.1016/j.jcin.2017.06.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/05/2017] [Accepted: 06/15/2017] [Indexed: 11/26/2022]
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Increasing propensity to pursue operative closure of atrial septal defects following changes in the instructions for use of the Amplatzer Septal Occluder device: An observational study using data from the Pediatric Health Information Systems database. Am Heart J 2017; 192:85-97. [PMID: 28938967 DOI: 10.1016/j.ahj.2017.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/12/2017] [Indexed: 11/21/2022]
Abstract
Concern for device erosion following transcatheter treatment of atrial septal defects (TC-ASD) led in 2012 to a United States Food and Drug Administration panel review and changes in the instructions for use of the Amplatzer Septal Occluder (ASO) device. No studies have assessed the effect of these changes on real-world practice. To this end a multicenter observational study was performed to evaluate trends in the treatment of ASD. METHODS A retrospective observational study was performed using data from the Pediatric Health Information Systems database of all patients with isolated ASD undergoing either TC-ASD or operative ASD closure (O-ASD) from January 1, 2007, to September 30, 2015, hypothesizing that the propensity to pursue O-ASD increased beginning in 2013. RESULTS A total of 6,392 cases from 39 centers underwent ASD closure (82% TC-ASD). Adjusting for patient factors, between 2007 and 2012, the probability of pursuing O-ASD decreased (odds ratio [OR] 0.95 per year, P = .03). This trend reversed beginning in 2013, with the probability of O-ASD increasing annually (OR 1.21, P = .006). There was significant between-hospital variation in the choice between TC-ASD and O-ASD (median OR 2.79, P < .0001). The age of patients undergoing ASD closure (regardless of method) decreased over the study period (P = .04). Cost of O-ASD increased over the study period, whereas cost of TC-ASD and length of stay for both O-ASD and TC-ASD was unchanged. CONCLUSIONS Although TC-ASD remains the predominant method of ASD closure, the propensity to pursue O-ASD has increased significantly following changes in instructions for use for ASO. Further research is necessary to determine what effect this has on outcomes and resource utilization.
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Villablanca PA, Briston DA, Rodés-Cabau J, Briceno DF, Rao G, Aljoudi M, Shah AM, Mohananey D, Gupta T, Makkiya M, Ramakrishna H, Garcia MJ, Pass RH, Peek G, Zaidi AN. Treatment options for the closure of secundum atrial septal defects: A systematic review and meta-analysis. Int J Cardiol 2017; 241:149-155. [DOI: 10.1016/j.ijcard.2017.03.073] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
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Nishida H, Nakatsuka D, Kawano Y, Hiraiwa N, Takanashi S, Tabata M. Outcomes of Totally Endoscopic Atrial Septal Defect Closure Using a Glutaraldehyde-Treated Autologous Pericardial Patch. Circ J 2017; 81:689-693. [PMID: 28179595 DOI: 10.1253/circj.cj-16-0888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We evaluated the outcomes of totally endoscopic minimally invasive surgery for atrial septal defect (ASD) using a glutaraldehyde-treated autologous pericardial patch in the transcatheter interventional era.Methods and Results:We retrospectively reviewed 37 consecutive patients who underwent totally endoscopic ASD closure with a glutaraldehyde-treated autologous pericardial patch between June 2011 and April 2015. All patients had been deferred from catheter-based intervention for clinical or anatomical reasons. We analyzed operative outcomes and postoperative echocardiographic data. The mean age was 45.7±16.5 years, and 25 patients (67.6%) were women. The mean ratio of pulmonary to systemic flow was 2.4±0.7. Six patients (16.2%) underwent concomitant tricuspid valve repair, and 3 patients (8.1%) underwent concomitant atrial fibrillation surgery. There were no operative deaths, and the median length of hospital stay was 5 days. Postoperative echocardiography revealed trivial residual shunt in 1 patient. During the follow-up period, there were no re-interventions for ASD or readmission for heart failure. Follow-up echocardiography revealed no recurrent shunt or calcification of the autologous pericardial patch. CONCLUSIONS Totally endoscopic ASD closure with a glutaraldehyde-treated autologous pericardial patch demonstrated excellent outcomes. It is a useful option for patients with unfavorable anatomy or other reasons excluding transcatheter intervention.
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Affiliation(s)
- Hidefumi Nishida
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Daisuke Nakatsuka
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
| | - Yuji Kawano
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
| | - Nobuhiko Hiraiwa
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
| | | | - Minoru Tabata
- Department of Cardiovascular Surgery, Sakakibara Heart Institute.,Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
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Takaya Y, Akagi T, Kijima Y, Nakagawa K, Watanabe N, Oe H, Taniguchi M, Ito H. Echocardiographic Estimates of Left Ventricular Diastolic Dysfunction Do Not Predict the Clinical Course in Elderly Patients Undergoing Transcatheter Atrial Septal Defect Closure: Impact of Early Diastolic Mitral Annular Velocity. J Interv Cardiol 2017; 30:79-84. [DOI: 10.1111/joic.12365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Teiji Akagi
- Cardiac Intensive Care Unit, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Yasufumi Kijima
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Nobuhisa Watanabe
- Division of Medical Support; Okayama University Hospital; Okayama Japan
| | - Hiroki Oe
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Manabu Taniguchi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
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Jalal Z, Hascoet S, Baruteau AE, Iriart X, Kreitmann B, Boudjemline Y, Thambo JB. Long-term Complications After Transcatheter Atrial Septal Defect Closure: A Review of the Medical Literature. Can J Cardiol 2016; 32:1315.e11-1315.e18. [DOI: 10.1016/j.cjca.2016.02.068] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/19/2016] [Accepted: 02/26/2016] [Indexed: 11/30/2022] Open
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Ooi YK, Kelleman M, Ehrlich A, Glanville M, Porter A, Kim D, Kogon B, Oster ME. Transcatheter Versus Surgical Closure of Atrial Septal Defects in Children: A Value Comparison. JACC Cardiovasc Interv 2016; 9:79-86. [PMID: 26762915 DOI: 10.1016/j.jcin.2015.09.028] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/04/2015] [Accepted: 09/08/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The purpose of this study was to determine whether a transcatheter procedure or surgical closure offers a better value proposition for atrial septal defect (ASD) closure. BACKGROUND Secundum ASDs are common congenital heart defects with both transcatheter and surgical treatment options. Although both options have been shown to have excellent results in children, the relative value of the 2 procedures is unclear. METHODS Using data from the Pediatric Hospital Information System for 2004 to 2012, we compared the value of transcatheter versus surgical ASD closure for children ages 1 to 17 years, with value being defined as outcomes relative to costs. Total charges for procedure-related encounters were converted to costs using hospital-specific cost-to-charge ratios, and all costs were adjusted for inflation to reflect 2012 dollars. RESULTS There were 4,606 transcatheter procedures and 3,159 surgeries at 35 children's hospitals. Those undergoing transcatheter closure were more likely to be older (5.6 years vs. 4.5 years, p < 0.0001). There was no mortality in either group. Children with a surgical procedure had a longer length of stay (4.0 days vs. 1.5 days, p < 0.0001), were more likely to have an infection (odds ratio: 3.73, p < 0.0001) or procedural complication (odds ratio: 6.66, p < 0.0001). Costs for transcatheter procedure encounters were lower than costs for surgical encounters (mean of $19,128 vs. $25,359, p < 0.0001). CONCLUSIONS Both transcatheter and surgical ASD closure had excellent short-term outcomes, but transcatheter procedures had lower lengths of stay, rates of infection, and complications, resulting in lower overall costs. For children who are eligible, transcatheter ASD closure provides better short-term value than surgery.
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Affiliation(s)
- Yinn Khurn Ooi
- Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
| | - Michael Kelleman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Alexandra Ehrlich
- Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Michelle Glanville
- Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Arlene Porter
- Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Dennis Kim
- Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Brian Kogon
- Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Matthew E Oster
- Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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Di Nora C, Negri F, Sinagra G, Antonini-Canterin F. A Large Ostium Secundum Atrial Septal Defect in an 88-Year-Old Asymptomatic Woman. J Am Geriatr Soc 2016; 64:e113-e115. [DOI: 10.1111/jgs.14406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zdradzinski MJ, Elkin RL, Lee JM, Qureshi AM, El-Mallah W, Krasuski RA. Contributors to and impact of residual shunting after device closure of atrial septal defects. Am Heart J 2016; 177:112-9. [PMID: 27297856 DOI: 10.1016/j.ahj.2016.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 03/30/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence of residual shunt in patients after device closure of atrial septal defect and its impact on long-term outcome has not been previously defined. METHODS From a prospective, single-institution registry of 408 patients, we selected individuals with agitated saline studies performed 1 year after closure. Baseline echocardiographic, invasive hemodynamic, and comorbidity data were compared to identify contributors to residual shunt. Survival was determined by review of the medical records and the Social Security Death Index. Survival analysis according to shunt included construction of Kaplan-Meier curves and Cox proportional hazards modeling. RESULTS Among 213 analyzed patients, 27% were men and age at repair was 47 ± 17 years. Thirty patients (14%) had residual shunt at 1 year. Residual shunt was more common with Helex (22%) and CardioSEAL/STARFlex (40%) occluder devices than Amplatzer devices (9%; P = .005). Residual shunts were more common in whites (79% vs 46%, P = .004). At 7.3 ± 3.3 years of follow-up, 13 (6%) of patients had died, including 8 (5%) with Amplatzer, 5 (25%) with CardioSEAL/STARFlex, and 0 with Helex devices. Patients with residual shunting had a higher hazard of death (20% vs 4%, P = .001; hazard ratio 4.95 [1.59-14.90]). In an exploratory multivariable analysis, residual shunting, age, hypertension, coronary artery disease, and diastolic dysfunction were associated with death. CONCLUSIONS Residual shunt after atrial septal defect device closure is common and adversely impacts long-term survival.
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Affiliation(s)
- Michael J Zdradzinski
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH
| | - Rachel L Elkin
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH
| | - Joanne M Lee
- Cardiovascular Medicine, Cleveland Clinic's Heart and Vascular Institute, Cleveland, OH
| | - Athar M Qureshi
- Pediatric Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Wael El-Mallah
- Cardiovascular Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Richard A Krasuski
- Cardiology Division, Duke University Health System/Duke University School of Medicine, Durham, NC.
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Minimally Invasive Repair of Partial Atrioventricular Canal Defect. Can J Cardiol 2016; 32:270.e3-5. [DOI: 10.1016/j.cjca.2015.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/17/2015] [Accepted: 05/17/2015] [Indexed: 11/20/2022] Open
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Meier B. Percutaneous Closure of Atrial Septal Defects: Contraindications Are Hard to Find These Days. JACC Cardiovasc Interv 2016; 8:607-8. [PMID: 25907087 DOI: 10.1016/j.jcin.2015.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 02/23/2015] [Accepted: 02/26/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Bernhard Meier
- Cardiovascular Department, University Hospital Bern, Bern, Switzerland.
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Transcatheter Versus Surgical Closure of Atrial Septal Defects. JACC Cardiovasc Interv 2016; 9:87-88. [PMID: 26762916 DOI: 10.1016/j.jcin.2015.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/10/2015] [Indexed: 11/22/2022]
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