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Vishwanath V, Akseer S, Frankfurter C, Reza S, Farrell A, Horlick E, Abrahamyan L. Comparative effectiveness of devices for transcatheter closure of atrial septal defects: Systematic review and network meta-analysis. Arch Cardiovasc Dis 2022; 115:664-674. [PMID: 36336619 DOI: 10.1016/j.acvd.2022.09.002] [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: 07/13/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022]
Abstract
Atrial septal defect is a common congenital heart disease, producing a left-to-right shunt in the atrial septum; the current preferred treatment is transcatheter device closure. The aim is to conduct a systematic review to synthesize information on the comparative effectiveness and safety of atrial septal defect closure devices. The methods used: a comprehensive search of Ovid MEDLINE®, Embase, and Cochrane Central databases was conducted. Studies comparing procedural and follow-up outcomes of atrial septal defect devices were included. Network meta-analyses were conducted to generate direct and indirect evidence for comparative effectiveness and safety outcomes between devices. The results are as follows: Twelve studies met our inclusion criteria and were compared in network meta-analyses. The meta-analyses evaluated contemporary devices: the AMPLATZER Septal Occluder; the GORE CARDIOFORM Septal Occluder; the Figulla Flexible II Occluder; the CeraFlex Septal Occluder; and the HELEX Septal Occluder. These studies represented 3998 patients. The primary safety and efficacy outcomes were device embolization and follow-up residual shunt, respectively. Secondary clinical outcomes included procedural success and major and minor complications. No differences were found between devices in terms of device embolization and secondary clinical outcomes. Follow-up residual shunt was higher with the HELEX Septal Occluder compared with the AMPLATZER Septal Occluder (odds ratio 2.92, 95% confidence interval 1.12-7.61). To conclude: although most outcomes were similar between devices, evidence was largely based on observational low-quality studies. There were inconsistencies in outcome reporting and definitions; this merits future studies, with head-to-head device comparisons and standardization of outcomes.
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Affiliation(s)
- Varnita Vishwanath
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, ON M5G 2N2 Toronto, Canada
| | - Selai Akseer
- Toronto General Hospital Research Institute, University Health Network, 10th Floor Eaton North, Room 237, 200, Elizabeth Street, ON M5G 2C4 Toronto, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto ON M5T 3M6, Canada
| | - Claudia Frankfurter
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, ON M5G 2N2 Toronto, Canada
| | - Seleman Reza
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto ON M5T 3M6, Canada
| | - Ashley Farrell
- Library & Information Services, University Health Network, Toronto ON M5G 2C4, Canada
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, ON M5G 2N2 Toronto, Canada
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network, 10th Floor Eaton North, Room 237, 200, Elizabeth Street, ON M5G 2C4 Toronto, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto ON M5T 3M6, Canada.
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Heaton JN, Okoh AK, Suh S, Ozturk E, Salemi A, Waxman S, Tayal R. Safety and Efficacy of the Amplatzer Septal Occluder: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 37:52-60. [PMID: 34183276 PMCID: PMC10909392 DOI: 10.1016/j.carrev.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/12/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the safety and efficacy of the Amplatzer Septal Occluder in the closure of secundum type atrial septal defects. BACKGROUND The Amplatzer Septal Occluder (ASO; Abbott, St. Paul, MN) is an FDA-approved device for percutaneous closure of secundum type atrial septal defects (ASD). Previous small cohort trials have shown a favorable safety and technical efficacy profile. METHODS We conducted a systemic review and meta-analysis of all prospective case series and controlled trials that evaluated the ASO's safety and implant efficacy. The primary endpoint was the technical success rate of implantations. Secondary outcomes included proportions of arrhythmias and embolism specific-adverse events. RESULTS We included a total of 12 studies with 2972 patients. The ratio of device implantation was 2:1 by sex [female: male]. Pooled technical success rate of implantation was 98% (95% CI: 0.968-0.990, P < 0.01). The cumulative adverse event rate was 5.1% (95% CI: 0.035-0.068, P < 0.01), which included arrhythmia and embolism specific adverse event rates of 1.8% (95% CI: 0.007-0.032, P < 0.01) and 0.7% (95% CI: 0.002-0.013, P < 0.01), respectively. Sensitivity analysis did not significantly affect pooled outcomes for success rate and adverse events; both forest plot and Begg's and Egger's regression tests supported symmetricity. CONCLUSION A high likelihood of technical success can be expected when implanting the ASO in secundum type ASDs. Adverse event rates are expected for one in twenty patients, and thus, our results support the safe use of ASO in secundum type ASDs closure. CONDENSED ABSTRACT The AMPLATZER Septal Occluder is an FDA-approved device for percutaneous closure of secundum type atrial septal defects (ASD). We conducted a systemic review and meta-analysis of all prospective case series and controlled trials that evaluated the ASO's safety and implant efficacy. We included a total of 12 studies with 2972 patients. Pooled technical success rate of implantation was 98% (P < 0.01). The cumulative adverse event rate was 5.1% (P < 0.01), 1.8% (P < 0.01) rate of arrhythmias, and 0.7% (P < 0.01) rate of embolisms. A high likelihood of technical success can be expected with a low rate of adverse events.
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Affiliation(s)
- Joseph N Heaton
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY, United States of America; Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America.
| | - Alexis K Okoh
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
| | - Seungmo Suh
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY, United States of America
| | - Ebru Ozturk
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
| | - Arash Salemi
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
| | - Sergio Waxman
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
| | - Rajiv Tayal
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
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Narayanan D, Kurien BB, Benjamin SR, Kuruvila KT, Philip MA, Thankachen R, George OK. Complications of trans-catheter closure of atrial septal defects. Indian J Thorac Cardiovasc Surg 2022; 38:262-267. [PMID: 35529019 PMCID: PMC9023636 DOI: 10.1007/s12055-022-01341-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 11/25/2022] Open
Abstract
Trans-catheter device closure of atrial septal defects (ASD) is considered to be safe with minimal complications. But, there are certain complications that arise after these device closures which might require urgent or late surgical intervention. We have retrospectively analysed our experience. Out of 780 patients who underwent device closure, 11 (1.4%) patients required urgent surgical intervention to retrieve the embolized device. The size of the ASD, expertise of the cardiologist and the type of the device directly impacted the rate of device embolization. Early diagnosis and prompt surgical retrieval is paramount before any life threatening complications arise due to the embolized device. One patient developed infective endocarditis later, which required surgery. Regular long term follow up is needed after these procedures to diagnose the complications earlier so that prompt surgical intervention could be done.
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Affiliation(s)
- Deepak Narayanan
- The Department of Cardiothoracic surgery, The Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Ben Babu Kurien
- The Department of Cardiothoracic surgery, The Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Santhosh Regini Benjamin
- The Department of Cardiothoracic surgery, The Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Korah Thomas Kuruvila
- The Department of Cardiothoracic surgery, The Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Madhu Andrew Philip
- The Department of Cardiothoracic surgery, The Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Roy Thankachen
- The Department of Cardiothoracic surgery, The Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Oomen Kattunilam George
- The Department of Cardiology, The Christian Medical College, Vellore, Tamil Nadu 632004 India
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Lin C, Liu L, Liu Y, Leng J. Recent developments in next-generation occlusion devices. Acta Biomater 2021; 128:100-119. [PMID: 33964482 DOI: 10.1016/j.actbio.2021.04.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/01/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
Transcatheter closure has been widely accepted as a highly effective way to treat abnormal blood flows and/or embolization of thrombus in the heart. It allows the closure of four types of congenital heart defects (CHDs) and stroke-associated left atrial appendage (LAA). The four types of CHDs include atrial septal defect (ASD), patent foramen ovale (PFO), patent ductus arteriosus (PDA), and ventricular septal defect (VSD). Advancements in the materials and configurations of occlusion devices have spurred the transition from open-heart surgery with high complexity and morbidity, or lifelong medication with a high risk of bleeding, to minimally invasive deployment. A variety of occlusion devices have been developed over the past few decades, particularly novel ones represented by biodegradable and 3D-printed occlusion devices, which are considered as next-generation alternatives to conventional Nitinol-based occlusion devices due to biodegradability, customization, and improved biocompatibility. The aim here is to comprehensively review the next-generation occlusion devices in terms of materials, configurations, manufacturing methods, deployment strategies, and (if available) experimental results or clinical data. The current challenges and the direction of future work are also proposed. STATEMENT OF SIGNIFICANCE: Implantation of occlusion devices has become a widely accepted and highly effective treatment for occluding abnormal blood/thrombus flow within the heart. Due to the serious complications such as erosion and displacement of conventional Nitinol-based occluders, next-generation occluders with reduced risk of complications and improved biocompatibility has emerged. Here, we comprehensively review the next-generation occluders developed for atrial septal defect (ASD), patent foramen ovale (PFO), patent ductus arteriosus (PDA), ventricular septal defect (VSD), and left atrial appendage (LAA), with special emphasis on biodegradable occluders. Besides, intelligent materials (e.g., automatically deployable shape memory polymers) and rapid customized manufacturing methods (3D/4D printing) for the fabrication of occluders are also introduced. Lastly, the directions of future work are highlighted.
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Affiliation(s)
- Cheng Lin
- Department of Astronautical Science and Mechanics, Harbin Institute of Technology (HIT), P.O. Box 301, No. 92 West Dazhi Street, Harbin 150001, People's Republic of China
| | - Liwu Liu
- Department of Astronautical Science and Mechanics, Harbin Institute of Technology (HIT), P.O. Box 301, No. 92 West Dazhi Street, Harbin 150001, People's Republic of China.
| | - Yanju Liu
- Department of Astronautical Science and Mechanics, Harbin Institute of Technology (HIT), P.O. Box 301, No. 92 West Dazhi Street, Harbin 150001, People's Republic of China
| | - Jinsong Leng
- Center for Composite Materials and Structures, Harbin Institute of Technology (HIT), P.O. Box 3011, No. 2 Yikuang Street, Harbin 150080, People's Republic of China.
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Shi D, Kang Y, Zhang G, Gao C, Lu W, Zou H, Jiang H. Biodegradable atrial septal defect occluders: A current review. Acta Biomater 2019; 96:68-80. [PMID: 31158496 DOI: 10.1016/j.actbio.2019.05.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/21/2019] [Accepted: 05/29/2019] [Indexed: 01/11/2023]
Abstract
Atrial septal defect (ASD) is a common structural congenital heart disease. With the development of interventional closure devices and transcatheter techniques, interventional closure therapy has become the most well-accepted therapeutic alternative worldwide, as it offers a number of advantages over conventional therapies such as improved safety, easier operation, lower complication rates and invasiveness, and shorter anesthetic time and hospitalizations. During the past decades, various types of occluders based on nondegradable shape memory alloys have been used in clinical applications. Considering that the permanent existence of foreign nondegradable materials in vivo can cause many potential complications in the long term, the research and development of biodegradable occluders has emerged as a crucial issue for interventional treatment of ASD. This review aims to summarize partially or fully biodegradable occlusion devices currently reported in the literature from the aspects of design, construction, and evaluation of animal experiments. Furthermore, a comparison is made on the advantages and disadvantages of the materials used in biodegradable ASD occlusion devices, followed by an analysis of the problems and limitations of the occlusion devices. Finally, several strategies are proposed for future development of biodegradable cardiac septal defect occlusion devices. STATEMENT OF SIGNIFICANCE: Although occlusion devices based on nondegradable alloys have been widely used in clinical applications and saved numerouspatients, biodegradable occlusion devices may offer some advantages such as fewer complications, acceptable biocompatibility, and particularly temporary existence, thereby leaving "native" tissue behind, which will certainly become the development trend in the long term. This review summarizes almost all partially or fully biodegradable occlusion devices currently reported in the literature from the aspects of design, construction, and evaluation of animal experiments. Furthermore, a comparison is made on the advantages and disadvantages of the materials used in biodegradable ASD occlusion devices, followed by an analysis of the problems and limitations of the occlusion devices. Finally, several strategies are proposed for future development of biodegradable cardiac septal defect occlusion devices.
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Bhattacharjya S, Pillai LS, Doraiswamy V, Satyanarayana RM, Chandrasekaran R, Pavithran S, Sivakumar K. Prospective concurrent head-to head comparison of three different types of nitinol occluder device for transcatheter closure of secundum atrial septal defects. EUROINTERVENTION 2019; 15:e321-e328. [DOI: 10.4244/eij-d-18-01016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Aubry P, Juliard JM, Brochet E. Atrial septal defect and ASO device: an unusual story. EUROINTERVENTION 2019; 15:e308-e309. [DOI: 10.4244/eijv15i4a56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Freed JK, Simon JA, Iqbal Z, Almassi GH, Pagel PS. An Unusual Cause of an Isolated Transient Ischemic Attack in an Otherwise Healthy Elderly Man. J Cardiothorac Vasc Anesth 2017; 32:1529-1532. [PMID: 28927695 DOI: 10.1053/j.jvca.2017.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Julie K Freed
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Jacqueline A Simon
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Zafar Iqbal
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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Huang Y, Wong YS, Ng HCA, Boey FYC, Venkatraman S. Translation in cardiovascular stents and occluders: From biostable to fully degradable. Bioeng Transl Med 2017; 2:156-169. [PMID: 29313029 PMCID: PMC5675095 DOI: 10.1002/btm2.10066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/16/2017] [Accepted: 06/18/2017] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular disease is a major cause of morbidity and mortality, especially in developed countries. Most academic research efforts in cardiovascular disease management focus on pharmacological interventions, or are concerned with discovering new disease markers for diagnosis and monitoring. Nonpharmacological interventions with therapeutic devices, conversely, are driven largely by novel materials and device design. Examples of such devices include coronary stents, heart valves, ventricular assist devices, and occluders for septal defects. Until recently, development of such devices remained largely with medical device companies. We trace the materials evolution story in two of these devices (stents and occluders), while also highlighting academic contributions, including our own, to the evolution story. Specifically, it addresses not only our successes, but also the challenges facing the translatability of concepts generated via academic research.
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Affiliation(s)
- Yingying Huang
- School of Materials Science and Engineering Nanyang Technological University Singapore 639798 Singapore
| | - Yee Shan Wong
- School of Materials Science and Engineering Nanyang Technological University Singapore 639798 Singapore
| | - Herr Cheun Anthony Ng
- School of Materials Science and Engineering Nanyang Technological University Singapore 639798 Singapore
| | - Freddy Y C Boey
- School of Materials Science and Engineering Nanyang Technological University Singapore 639798 Singapore
| | - Subbu Venkatraman
- School of Materials Science and Engineering Nanyang Technological University Singapore 639798 Singapore
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Large single centre experience with the Cera™ and CeraFlex™ occluders for closure of interatrial communications: usefulness of the flexible rotation feature. Cardiovasc Interv Ther 2016; 33:70-76. [DOI: 10.1007/s12928-016-0440-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
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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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Nassif M, Abdelghani M, Bouma BJ, Straver B, Blom NA, Koch KT, Tijssen JGP, Mulder BJM, de Winter RJ. Historical developments of atrial septal defect closure devices: what we learn from the past. Expert Rev Med Devices 2016; 13:555-68. [PMID: 27112301 DOI: 10.1080/17434440.2016.1182860] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Since King and Mills' pioneering work in percutaneous closure devices of secundum atrial septal defects (ASD) four decades ago, developments in device shape, material and implantation technique led to adoption of percutaneous ASD closure as current treatment of choice. Not only was the feasibility of such a percutaneous procedure tested altogether, but pursuing the ideal device in terms of safety and efficacy became priority. AREAS COVERED In this review we present the historical development of ASD devices in design, material and technique with clinical data, and provide the future perspectives in percutaneous ASD closures. EXPERT OPINION An 'ideal device' requires complete defect closure with negligible risk of complications using a safe, straightforward delivery technique with repositioning and retrieving properties. Some of the devices currently at hand come close to fulfilling these criteria, however none seem to provide those prerequisites completely. By understanding how challenges in device development were overcome in the past, new insights into future improvements are given.
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Affiliation(s)
- Martina Nassif
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Mohammad Abdelghani
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Berto J Bouma
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Bart Straver
- b Department of Pediatric Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Nico A Blom
- b Department of Pediatric Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Karel T Koch
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Jan G P Tijssen
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Barbara J M Mulder
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands.,c Interuniversity Cardiology Institute of the Netherlands (ICIN) , Utrecht , The Netherlands
| | - Robbert J de Winter
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
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Bissessor N. Current perspectives in percutaneous atrial septal defect closure devices. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2015; 8:297-303. [PMID: 26203289 PMCID: PMC4508077 DOI: 10.2147/mder.s49368] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In the last decade, percutaneous atrial septal defect (ASD) closure has become the treatment of choice in most clinical presentations of ASD. Percutaneous ASD closure has established procedural safety through operator experience and improved device structure and deliverability. There have also been advances in diagnostic capabilities. Devices have evolved from large bulky meshes to repositionable, minimal residual mesh content that easily endothelializes and conforms well to surrounding structures. Biodegradable technology has been introduced and will be closely watched as a future option. The evolution of ASD closure device usage in the last four decades incorporates development that minimizes a wide range of serious side effects that have been reported over the years. Complications reported in the literature include thrombus formation, air embolization, device embolization, erosions, residual shunts, and nickel hypersensitivity. Modern devices have intermediate to long term data with outcomes that have been favorable. Devices are available in multiple sizes with improved delivery mechanisms to recapture, reposition, and safely close simple and complex ASDs amenable to percutaneous closure. In this review, commonly used devices and deployment procedures are discussed together with a look at devices that show promise for the future.
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Affiliation(s)
- N Bissessor
- Department of Cardiology, The Epworth Hospital, Melbourne, VIC, Australia
- Division of Interventional Cardiology, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Clinical Science, Charles Sturt University Albury Campus, NSW, Australia
- Heart Foundation, Griffith University, QLD, Australia
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