Transcatheter closure of large atrial septal defects: A single-center experience

Background: Despite the favorable history of surgical approach to repair secundum type atrial septal defects (ASDs), the transcatheter closure has increasingly become the preferred strategy because of its relatively high efficacy and lower morbidity compared to surgery in selected cases. However, there is some controversy around the preferred strategy and long-term complications of device closure of large ASDs. Here, we evaluated the early and midterm outcomes of adults with large ASDs who underwent transcatheter device closure with devices larger than 28 mm. Methods: A prospective single-center study was conducted encompassing all the patients who were 18 years of age or older and underwent device closure for secundum type ASD from 2006 to 2014 with device size of >28 mm, and early and midterm follow-up data were assessed. Results: The procedure was successful in 93.6% of the scheduled patients. Two and a half percent had nonsignificant residual shunt. Immediate device migration occurred in one patient (1.2%) who underwent surgical retrieval and defect closure. One case of device thrombosis (1.2%) was seen 1 month after the procedure who had successful medical treatment. There was a case of device erosion 1 month after the procedure referred for the surgery. Mild postintervention pericardial effusion was seen in 16.5% and reduced to 7.6% in the first outpatient visit. Conclusions: The study demonstrated that the vast majority of anatomically suitable large ASDs could be closed by using the transcatheter technique with a low complication rate. Therefore, the transcatheter closure could be recommended as the first-line strategy in adults with large ASDs. However, meticulous preprocedural imaging and evaluation by experts are necessary before scheduling patients with large ASDs for the percutaneous alternative.