Long-term follow-up of percutaneous closure of secudnum atrial septal defect

  • Gianfranco Butera, Policlinico San Donato IRCCS, Italy
  • Tommaso Infusino, Policlinico San Donato IRCCS, Italy
  • Paolo Ferrero, Policlinico San Donato IRCCS, Italy
  • Mario Carminati, Policlinico San Donato IRCCS, Italy
  • Alessandro Frigiola, Policlinico San Donato IRCCS, Italy
  • Sara Foresti, Policlinico San Donato IRCCS, Italy
  • Massimo Chessa, Policlinico San Donato IRCCS, Italy
  • Riccardo Cappato, Policlinico San Donato IRCCS, Italy

    • OBJECTIVES
    To study long-term results of percutaneous closure of secundum ASD.

    METHODS
    Between January 2000 and January 2004, 333 (111 males) patients underwent percutaneous closure of secundum ASD. All patients were included in the present study and followed up. Median age at implantation was 30 years (2-81). Comorbidities were present in 84 subjects (26%). Median NYHA class was I (range I-IV). Mean ASD diameter was 21±6 mm. Qp/Qs ratio and sistolic pulmonary pressures were 2±0.5 and 16±4 mmHg, respectively.

    RESULTS
    Closure was performed by using an Amplatzer device in 289 pts (86%) and a StarFlex device in 44 (14%). Procedure and fluoroscopic times were 68±28 and 12±9 minutes, respectively. Complex ASD (Multiple ASD, ASD+atrial septal aneurysm) were treated in 48 pts (15%).
    Procedure was successfully performed in 317 pts (95%). Significant early complications (within 1 month) occurred in pts 11 (3.3%) (device embolization needing cardiac surgery, cardiac tamponade, intraoperative TIA, device thrombosis). Patients were followed up for 6+/-1 years. Complete closure was shown in all patients. We reported no case of late device embolization, thrombus formation, endocarditis. NYHA class improved significantly (NYHA I pre-procedure: 60% versus 85% post-procedure; p=0.001). Arrhythmias improved after closure (pre-procedure: 16% versus post-procedure: 10%; p=0.04). Late reintervention was needed in 5 pts (1.5%) : occurrence of aorto-right atrial fistula (1 pt), development of significant mitral insufficiency (1 pt), vascular surgery due to the occurrence of femoral artero-venous fistula (3 pts).

    CONCLUSIONS
    Percutaneous ASD closure is safe and effective.Early results are stable during long-term follow-up.