Transcatheter closure of ostium secundum atrial septal defects in 2,253 children and adults: early outcomes

Transcatheter closure of ostium secundum atrial septal defect (osASD) is the first line treatment in most children and adults since the 2000s. Some major adverse events (MAE) such as aortic erosion have been infrequently reported. This study aims to report early outcomes and investigate risk factors associated with MAE. This prospective, single-center, cohort study included 2253 consecutive patients referred for transcatheter osASD with Amplatzer septal occluder (ASO) (Abbott®) between May 1998 and December 2021. Peri-procedural data associated with MAE at one-month were investigated. Of 2253 patients, 1388 (61.6%) cases were performed in adults, 865 (38.4%) in children including 38 (1.7%) weighing less than 15 kgs. Mean osASD diameter was 18±7 mm, 22.7% had a deficient aortic rim and 0.9% a deficient inferior vena cava rim. Procedural success was achieved in 98.1%. Thirty-two peri-procedural MAE occurred in 31 patients (1.4%) including 2 cardiac erosions (0.1%) and 19 device embolizations (0.8%). No peri-procedural death was reported. There was no significant difference in the incidence of MAE between age and weight subgroups. Deficiency of the inferior vena cava rim and osASD size/Body Surface Area ratio ≥20 mm/m² were significantly associated with MAE (p=0.002 and p=0.035, respectively) in a multivariate logistic regression analysis. Transcatheter osASD closure using ASO is effective with a high procedural success across a broad population of children and adults. Although MAE are rare, some predictive anatomical features are identified such as inferior vena cava deficiency and defect diameter.