Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Mar 26, 2015; 7(3): 150-156
Published online Mar 26, 2015. doi: 10.4330/wjc.v7.i3.150
Percutaneous closure of secundum type atrial septal defects: More than 5-year follow-up
Roel JR Snijder, Maarten J Suttorp, Jurriën M Ten Berg, Martijn C Post
Roel JR Snijder, Maarten J Suttorp, Jurriën M Ten Berg, Martijn C Post, Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
Author contributions: Snijder RJ, Suttorp MJ, Ten Berg JM and Post MC had substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; Snijder RJ drafted the article; Suttorp MJ, Ten Berg JM and Post MC revised the article critically for important intellectual content; all authors gave final approval for publication.
Ethics approval: United Committee for Human Bound Research approval code: V.32916/W14.082/sw/mk.
Informed consent: All patients provided informed oral consent. Further, our institutional review board approved our study and stated that no informed written consent was necessary.
Conflict-of-interest: None of the authors had a conflict of interest.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Martijn C Post, MD, PhD, Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands. m.post@antoniusziekenhuis.nl
Telephone: +31-88-3203000 Fax: +31-30-6034420
Received: October 28, 2014
Peer-review started: October 29, 2014
First decision: November 27, 2014
Revised: January 14, 2015
Accepted: January 30, 2015
Article in press: February 2, 2015
Published online: March 26, 2015
Abstract

AIM: To investigate long-term efficacy of two different devices more than five years after percutaneous atrial septal defect (ASD) closure in adults.

METHODS: All patients who underwent percutaneous closure of an ASD in the St. Antonius Hospital, Nieuwegein, The Netherlands, between February 1998 and December 2006 were included. Percutaneous closure took place under general anaesthesia and transesophageal echocardiographic monitoring. Transthoracic echocardiography (TTE) was performed 24 h post-procedure to visualize the device position and to look for residual shunting using color Doppler. All complications were registered. All patients were invited for an outpatient visit and contrast TTE more than 5-years after closure. Efficacy was based on the presence of a residual right-to-left shunt (RLS), graded as minimal, moderate or severe. The presence of a residual left-to-right shunt (LRS) was diagnosed using color Doppler, and was not graded. Descriptive statistics were used for patients’ characteristics. Univariate analysis was used to identify predictors for residual shunting.

RESULTS: In total, 104 patients (mean age 45.5 ± 17.1 years) underwent percutaneous ASD closure using an Amplatzer device (ASO) in 76 patients and a Cardioseal/Starflex device (CS/SF) in 28 patients. The mean follow-up was 6.4 ± 3.4 years. Device migration occurred in 4 patients of whom two cases occurred during the index hospitalization (1 ASO, 1 CS/SF). The other 2 cases of device migration occurred during the first 6 mo of follow-up (2 CS/SF). The recurrent thrombo-embolic event rate was similar in both groups: 0.4% per follow-up year. More than 12 mo post-ASD closure and latest follow-up, new-onset supraventricular tachyarrhythmia’s occurred in 3.9% and 0% for the ASO and CS/SF group, respectively. The RLS rate at latest follow-up was 17.4% (minimal 10.9%, moderate 2.2%, severe 4.3%) and 45.5% (minimal 27.3%, moderate 18.2%, severe 0%) for the ASO- and CS/SF groups, respectively. There was no residual LRS in both groups.

CONCLUSION: Percutaneous ASD closure has good long-term safety and efficacy profiles. The residual RLS rate seems to be high more than 5 years after closure, especially in the CS/SF. Residual LRS was not observed.

Keywords: Percutaneous intervention, Atrial septal defect, Closure device, Right-to-left interatrial shunt, Left-to-right interatrial shunt, Echocardiography

Core tip: Several atrial septal defect (ASD) closing devices have been proven safe and effective for percutaneous ASD closure. We evaluated long-term (i.e., more than 5-year of follow-up) efficacy of two different devices used in adults. Percutaneous ASD closure seems to be relatively safe using the Amplatzer device. Though, the right-to-left shunt (RLS) rate is high, a residual left-to-right shunt was absent at latest follow up. The Cardioseal/Starflex device appears to be associated with a higher complication- and residual RLS rate. The importance of a residual RLS is unclear. Therefore, long-term follow up might be necessary.