Key result
Transcatheter ASD closure with TOE guidance alone achieved a 97% success rate compared to 96% with fluoroscopy, with fewer intraprocedural complications (0.6% vs 3.3%).
Why the study?
The study was conducted to compare the feasibility, effectiveness, safety, and outcome of transcatheter atrial septal defect device closure in children with versus without fluoroscopy guidance.
Does transcatheter ASD closure with TOE guidance alone improve safety and procedure time compared to fluoroscopy guidance in children?
Cohort (n=397)
No
Does transcatheter ASD closure with TOE guidance alone improve safety and procedure time compared to fluoroscopy guidance in children?
Transcatheter ASD closure using TOE guidance alone is as effective and safe as fluoroscopy guidance, with shorter procedure times and fewer intraprocedural complications.
Answers are grounded in this paper and cite their sources.
Supports TOE guidance alone for ASD closure to potentially reduce complications; leaves open confirmation in randomized trials.
OBJECTIVE: The aim of this study was to compare feasibility, effectiveness, safety, and outcome of atrial septal defect (ASD) device closure in children with and without fluoroscopy guidance. METHODS AND RESULTS: Children undergoing transcatheter ASD closure between 2002 and 2016 were included into this single center, retrospective study. Patients were analysed in two groups [1: intraprocedural fluoroscopy ± transoesophageal echocardiography (TOE) guidance; 2: TOE guidance alone]. Three-hundred-ninety-seven children were included, 238 (97 male) in group 1 and 159 (56 male) in group 2. Two-hundred-twenty-nine of 238 (96%) patients underwent successful fluoroscopy guided ASD closures versus 154/159 (97%) successful procedures with TOE guidance alone. Median weight (IQR) at intervention was 20kg (16.0-35.0) in group 1 versus 19.3kg (16.0-31.2) in group 2. Mean (SD) preinterventional ASD diameter was 12.4mm (4.4) in group 1 versus 12.2mm (3.9) in group 2. There was no significant difference in number of defects or characteristics of ASD rims. Median procedure time was shorter in group 2 [60min (47-86) versus 34min (28-44)]. Device-size-to-defect-ratio was similar in both groups [group 1: 1.07 versus group 2: 1.09]. There were less technical intraprocedural events in group 2 [10 (6.3%) versus 47 (20%)]. Intraprocedural complications were less frequent in group 2 [1 (0.6%) versus 8 (3.3%)]. CONCLUSION: Transcatheter ASD device closure with TOE guidance alone (i.e., without fluoroscopy) is as effective and safe as ASD closure with fluoroscopy guidance. As fluoroscopy remains an important adjunct to transoesophageal echocardiography, especially in complex defects and complications, procedures are always performed in a fully equipped cardiac catheterization laboratory.
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Ackermann et al. (2019) conducted a cohort in Atrial septal defect (ASD) (n=397). Transoesophageal echocardiography (TOE) guidance alone vs. Intraprocedural fluoroscopy ± TOE guidance was evaluated on Successful ASD closure. Transcatheter ASD closure with TOE guidance alone achieved a 97% success rate compared to 96% with fluoroscopy, with fewer intraprocedural complications (0.6% vs 3.3%).
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