Transcatheter closure of atrial septal defect in the elderly: Early outcomes and mid-term follow-up

Background: Elderly patients (>= 60 years) with an atrial septal defect (ASD) are a complex subgroup with several haemodynamic limitations. The aim of this study is to describe the clinical and haemodynamic features of these patients and the effectiveness of percutaneous ASD closure in this setting.Methods: This is an observational retrospective study. From 2000 to 2018, sixty-eight elderly patients (65.1 +/- 3.8 years, range 60-75) underwent ASD assessment at our institution. Right heart catheterization was always performed before closing the ASD. At last follow-up, clinical and echocardiographic data were recorded.Results: Among these 68 elderly patients, in 62 cases (91.2%) with a favourable haemodynamic profile, ASD closure was performed immediately. In 2 patients the ASD was closed after 3 months of medical therapy. A fenestrated device was used in 1 case. The remaining 3 patients with pulmonary arterial hypertension (PAH) and high pulmonary vascular resistance (>4.6 WU) were treated with PAH specific therapy. At a mean follow-up of 4.3 +/- 1.5 years, a significant improvement of NYHA class (pre-interventional NYHA III-IV 21.5% vs. post-interventional NYHA III-IV 4.6%; p < 0.01) was detected. Echocardiography revealed a significant decrease of right ventricular basal (45.9 +/- 5.5 mm vs. 41.0 +/- 4.6 mm; p < 0.01), mid-cavity (40.5 +/- 5.4 mm vs. 35.6 +/- 5.4 mm; p < 0.01), and longitudinal end-diastolic diameters (73.8 +/- 6.6 mm vs. 68.4 +/- 5.8 mm; p < 0.01), without significant changes in left atrial volume (33.0 +/- 15.1 mL/m(2) vs. 32.8 +/- 13.6 mL/m(2); p = 0.5) and left ventricular diastolic function.Conclusions: Transcatheter ASD closure is safe and feasible in elderly patients, allowing a favourable remodelling of the right ventricle with symptom improvement.