Safety, feasibility, and long-term results of percutaneous closure of atrial septal defects using the Amplatzer septal occluder without periprocedural echocardiography.

Praz, Fabien; Wahl, Andreas; Schmutz, Mathieu; Pfammatter, Jean-Pierre; Pavlovic, Mladen; Perruchoud, Stéphanie; Remondino, Andrea; Windecker, Stephan; Meier, Bernhard (2015). Safety, feasibility, and long-term results of percutaneous closure of atrial septal defects using the Amplatzer septal occluder without periprocedural echocardiography. The journal of invasive cardiology, 27(3), pp. 157-162. HMP Communications

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OBJECTIVES

We sought to assess the safety and efficacy of percutaneous closure of atrial septal defects (ASDs) under fluoroscopic guidance only, without periprocedural echocardiographic guidance.

BACKGROUND

Percutaneous closure of ASDs is usually performed using simultaneous fluoroscopic and transthoracic, transesophageal (TEE), or intracardiac echocardiographic (ICE) guidance. However, TEE requires deep sedation or general anesthesia, which considerably lengthens the procedure. TEE and ICE increase costs.

METHODS

Between 1997 and 2008, a total of 217 consecutive patients (age, 38 ± 22 years; 155 females and 62 males), of whom 44 were children ≤16 years, underwent percutaneous ASD closure with an Amplatzer ASD occluder (AASDO). TEE guidance and general anesthesia were restricted to the children, while devices were implanted under fluoroscopic guidance only in the adults. For comparison of technical safety and feasibility of the procedure without echocardiographic guidance, the children served as a control group.

RESULTS

The implantation procedure was successful in all but 3 patients (1 child and 2 adults; 1.4%). Mean device size was 23 ± 8 mm (range, 4-40 mm). There was 1 postprocedural complication (0.5%; transient perimyocarditis in an adult patient). At last echocardiographic follow-up, 13 ± 23 months after the procedure, 90% of patients had no residual shunt, whereas a minimal, moderate, or large shunt persisted in 7%, 1%, and 2%, respectively. Four adult patients (2%) underwent implantation of a second device for a residual shunt. During a mean follow-up period of 3 ± 2 years, 2 deaths and 1 ischemic stroke occurred.

CONCLUSION

According to these results, percutaneous ASD closure using the AASDO without periprocedural echocardiographic guidance seems safe and feasible.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
UniBE Contributor:	Praz, Fabien Daniel, Wahl, Andreas, Schmutz, Mathieu, Pfammatter, Jean-Pierre, Pavlovic, Mladen, Windecker, Stephan, Meier, Bernhard
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1557-2501
Publisher:	HMP Communications
Language:	English
Submitter:	Fabien Praz
Date Deposited:	22 Jun 2016 14:56
Last Modified:	02 Mar 2023 23:27
PubMed ID:	25740969
URI:	https://boris.unibe.ch/id/eprint/76511