Transcatheter closure of atrial septal defects with multiple devices in adults: Procedural and clinical outcomes

Objective: This study reports the procedural, short and medium term outcomes in patients receiving multiple implants for device closure of secundum atrial septal defects (ASD). Design and setting: From the database of the Toronto Congenital Cardiac Centre, 36 consecutive patients (mean age 46 +/- 15 years; 23 females) received > 1 implant for closure of an interatrial communication. Short term (mean 97 +/- 77 days) and medium term (mean 2.5 +/- 1.4 years) follow-up data were analyzed. Procedures were performed under intracardiac echo (ICE) and fluoroscopic guidance. Results: The Amplatzer Septal Occluder (ASO (TM)) was implanted in all except one. Thirty-one patients had 2, and 4 patients, 3 ASO (TM) devices. There were no major adverse events at implantation or on follow-up. Patients with > NYHA class I symptoms fell from 44% to 6% (p < 0.05) at 3 months. Right ventricular (RV) systolic pressure fell from 39 +/- 7 to 32 +/- 4 mm Hg in the short term (p < 0.05), and to 30 +/- 4 mm Hg in the medium term (p < 0.05, compared to baseline) and RV diameters fell from 48 +/- 5 to 40 +/- 5 (p < 0.05) in the short term and to 38 +/- 8 mm (p=ns) in the medium term. Small residual leaks were present in 22% at 3 months and 12% (p < 0.05) at 1 year. Conclusion: Multiple ASD device implants can be safely employed with excellent outcomes. Significant reductions in RV pressure and diameter occur in the short term with a continued trend to benefit. (c) 2008 Elsevier Ireland Ltd. All rights reserved.