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MacDonald ST, Daniels MJ, Ormerod OJ. Initial use of the new GORE(®) septal occluder in patent foramen ovale closure: implantation and preliminary results. Catheter Cardiovasc Interv 2012; 81:660-5. [PMID: 23436483 DOI: 10.1002/ccd.24405] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 12/14/2011] [Accepted: 03/03/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND A number of devices are available for percutaneous closure of a clinically significant patent foramen ovale (PFO). The new GORE(®) septal occluder (GSO) is a nonself-centering device consisting of an expanded polytetrafluoroethylene tube supported by a frame of nitinol wire conforming into a double disk. This study reports the first clinical GSO implantation experience. METHODS GSO implantation in 20 consecutive patients is reported. Inclusion criteria were all patients referred with a significant PFO implicated in paradoxical embolism or transient right to left shunting causing desaturation. Procedures were performed under local anaesthesia and intracardiac echocardiography (ICE) in addition to fluoroscopy. Procedural data, acute and early closure rates were examined. RESULTS All patients underwent successful day-case device implantation. Eleven patients had previous stroke, five had transient ischemic attacks, two had a history suspicious of PFO-related desaturation, and two had a history suspicious of PFO-related peripheral thromboembolism. Acute closure rates on IVC injection bubble testing were 100% at implant and 100% (14/14) at 1 month. Average PFO balloon size was 8.0 ± 3.6(range 2.0-16.7) mm, mean fluoroscopic implantation time 3.0 ± 1.7(range 0.7-6.3) min, radiation dose 283 ± 340 (range 6-1,431) μGym(2), and total procedural time 34.8 ± 8.0 (range 22-53) min. 5 × 20 mm(2), 7 × 25 m(2), 8 × 30 mm(2) GSO devices were implanted, aiming for device size at least twice balloon PFO size. Cases included aneurysmal septums with up to 30 mm deviation and tunnels up to 12 mm long. Removal and repositioning of two devices was performed on two occasions after uncertainty about device locking. At 1 month follow-up, two patients had brief self-terminating episodes of suspected atrial fibrillation, all had normal resting ECGs. No thromboembolic/neurological events were reported. CONCLUSIONS The GSO can be implanted under local anaesthesia and ICE with low procedural and fluoroscopy times with high procedural success as a day case. No residual shunts were seen. This initial experience suggests that it is a safe and effective device for PFO closure.
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Affiliation(s)
- Simon T MacDonald
- Department of Cardiology, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, United Kingdom
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Zomer A, Verheugt C, Vaartjes I, Uiterwaal C, Langemeijer M, Koolbergen D, Hazekamp M, van Melle J, Konings T, Bellersen L, Grobbee D, Mulder B. Surgery in Adults With Congenital Heart Disease. Circulation 2011; 124:2195-201. [DOI: 10.1161/circulationaha.111.027763] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A.C. Zomer
- From the Departments of Cardiology (A.C.Z., B.J.M.M.) and Pediatric Cardiac Surgery (D.R.K., M.G.H.), Academic Medical Center, Amsterdam; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (A.C.Z., I.V., C.S.P.M.U., D.E.G.); Interuniversity Cardiology Institute of the Netherlands, Utrecht (A.C.Z., M.M.L., B.J.M.M.); Departments of Internal Medicine (C.L.V.), and Cardiology (T.C.K.), VU University Medical Center, Amsterdam; Department of Cardiothoracic
| | - C.L. Verheugt
- From the Departments of Cardiology (A.C.Z., B.J.M.M.) and Pediatric Cardiac Surgery (D.R.K., M.G.H.), Academic Medical Center, Amsterdam; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (A.C.Z., I.V., C.S.P.M.U., D.E.G.); Interuniversity Cardiology Institute of the Netherlands, Utrecht (A.C.Z., M.M.L., B.J.M.M.); Departments of Internal Medicine (C.L.V.), and Cardiology (T.C.K.), VU University Medical Center, Amsterdam; Department of Cardiothoracic
| | - I. Vaartjes
- From the Departments of Cardiology (A.C.Z., B.J.M.M.) and Pediatric Cardiac Surgery (D.R.K., M.G.H.), Academic Medical Center, Amsterdam; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (A.C.Z., I.V., C.S.P.M.U., D.E.G.); Interuniversity Cardiology Institute of the Netherlands, Utrecht (A.C.Z., M.M.L., B.J.M.M.); Departments of Internal Medicine (C.L.V.), and Cardiology (T.C.K.), VU University Medical Center, Amsterdam; Department of Cardiothoracic
| | - C.S.P.M. Uiterwaal
- From the Departments of Cardiology (A.C.Z., B.J.M.M.) and Pediatric Cardiac Surgery (D.R.K., M.G.H.), Academic Medical Center, Amsterdam; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (A.C.Z., I.V., C.S.P.M.U., D.E.G.); Interuniversity Cardiology Institute of the Netherlands, Utrecht (A.C.Z., M.M.L., B.J.M.M.); Departments of Internal Medicine (C.L.V.), and Cardiology (T.C.K.), VU University Medical Center, Amsterdam; Department of Cardiothoracic
| | - M.M. Langemeijer
- From the Departments of Cardiology (A.C.Z., B.J.M.M.) and Pediatric Cardiac Surgery (D.R.K., M.G.H.), Academic Medical Center, Amsterdam; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (A.C.Z., I.V., C.S.P.M.U., D.E.G.); Interuniversity Cardiology Institute of the Netherlands, Utrecht (A.C.Z., M.M.L., B.J.M.M.); Departments of Internal Medicine (C.L.V.), and Cardiology (T.C.K.), VU University Medical Center, Amsterdam; Department of Cardiothoracic
| | - D.R. Koolbergen
- From the Departments of Cardiology (A.C.Z., B.J.M.M.) and Pediatric Cardiac Surgery (D.R.K., M.G.H.), Academic Medical Center, Amsterdam; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (A.C.Z., I.V., C.S.P.M.U., D.E.G.); Interuniversity Cardiology Institute of the Netherlands, Utrecht (A.C.Z., M.M.L., B.J.M.M.); Departments of Internal Medicine (C.L.V.), and Cardiology (T.C.K.), VU University Medical Center, Amsterdam; Department of Cardiothoracic
| | - M.G. Hazekamp
- From the Departments of Cardiology (A.C.Z., B.J.M.M.) and Pediatric Cardiac Surgery (D.R.K., M.G.H.), Academic Medical Center, Amsterdam; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (A.C.Z., I.V., C.S.P.M.U., D.E.G.); Interuniversity Cardiology Institute of the Netherlands, Utrecht (A.C.Z., M.M.L., B.J.M.M.); Departments of Internal Medicine (C.L.V.), and Cardiology (T.C.K.), VU University Medical Center, Amsterdam; Department of Cardiothoracic
| | - J.P. van Melle
- From the Departments of Cardiology (A.C.Z., B.J.M.M.) and Pediatric Cardiac Surgery (D.R.K., M.G.H.), Academic Medical Center, Amsterdam; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (A.C.Z., I.V., C.S.P.M.U., D.E.G.); Interuniversity Cardiology Institute of the Netherlands, Utrecht (A.C.Z., M.M.L., B.J.M.M.); Departments of Internal Medicine (C.L.V.), and Cardiology (T.C.K.), VU University Medical Center, Amsterdam; Department of Cardiothoracic
| | - T.C. Konings
- From the Departments of Cardiology (A.C.Z., B.J.M.M.) and Pediatric Cardiac Surgery (D.R.K., M.G.H.), Academic Medical Center, Amsterdam; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (A.C.Z., I.V., C.S.P.M.U., D.E.G.); Interuniversity Cardiology Institute of the Netherlands, Utrecht (A.C.Z., M.M.L., B.J.M.M.); Departments of Internal Medicine (C.L.V.), and Cardiology (T.C.K.), VU University Medical Center, Amsterdam; Department of Cardiothoracic
| | - L. Bellersen
- From the Departments of Cardiology (A.C.Z., B.J.M.M.) and Pediatric Cardiac Surgery (D.R.K., M.G.H.), Academic Medical Center, Amsterdam; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (A.C.Z., I.V., C.S.P.M.U., D.E.G.); Interuniversity Cardiology Institute of the Netherlands, Utrecht (A.C.Z., M.M.L., B.J.M.M.); Departments of Internal Medicine (C.L.V.), and Cardiology (T.C.K.), VU University Medical Center, Amsterdam; Department of Cardiothoracic
| | - D.E. Grobbee
- From the Departments of Cardiology (A.C.Z., B.J.M.M.) and Pediatric Cardiac Surgery (D.R.K., M.G.H.), Academic Medical Center, Amsterdam; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (A.C.Z., I.V., C.S.P.M.U., D.E.G.); Interuniversity Cardiology Institute of the Netherlands, Utrecht (A.C.Z., M.M.L., B.J.M.M.); Departments of Internal Medicine (C.L.V.), and Cardiology (T.C.K.), VU University Medical Center, Amsterdam; Department of Cardiothoracic
| | - B.J.M. Mulder
- From the Departments of Cardiology (A.C.Z., B.J.M.M.) and Pediatric Cardiac Surgery (D.R.K., M.G.H.), Academic Medical Center, Amsterdam; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (A.C.Z., I.V., C.S.P.M.U., D.E.G.); Interuniversity Cardiology Institute of the Netherlands, Utrecht (A.C.Z., M.M.L., B.J.M.M.); Departments of Internal Medicine (C.L.V.), and Cardiology (T.C.K.), VU University Medical Center, Amsterdam; Department of Cardiothoracic
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