What question did this study set out to answer?

To evaluate the clinical safety, efficacy, and procedural outcomes of intracardiac echocardiography (ICE) guidance compared to transesophageal echocardiography (TEE) guidance during transcatheter closure of secundum atrial septal defects.

January 1, 2012Circulation JournalOpen Access

Eight-French Intracardiac Echocardiography

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Secundum atrial septal defect (n=560). Intervention: 8-Fr Intracardiac echocardiography (ICE) guidance vs. Trans-esophageal echocardiography (TEE) guidance. Primary outcome: Procedure time (minutes) (p=<0.001).

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Key result

8-Fr intracardiac echocardiography guidance for transcatheter closure of atrial septal defects significantly reduced procedure time compared to trans-esophageal echocardiography (67.7 vs 94.2 minutes) while avoiding general anesthesia.

Why the study?

Does intracardiac echocardiography (ICE) guidance improve procedural outcomes and reduce procedure time compared to trans-esophageal echocardiography (TEE) in patients undergoing transcatheter closure of atrial septal defects?

Population

560 patients undergoing transcatheter closure of secundum atrial septal defect using Amplatzer septal…

Comparison

Intracardiac echocardiography guidance using an… vs Trans-esophageal echocardiography guidance…

Design

Cohort

Authors

NKNam Kyun KimYonsei University SPSu-Jin ParkUniversity Health System JSJae Il ShinYonsei University Health System

Discussion

Member takes

Implication

ICE guidance may shorten ASD closure and avoid general anesthesia; leaves open confirmation in randomized trials.

Key Points

To evaluate the clinical safety, efficacy, and procedural outcomes of intracardiac echocardiography (ICE) guidance compared to transesophageal echocardiography (TEE) guidance during transcatheter closure of secundum atrial septal defects.
Retrospective single-center analysis of 560 consecutive patients undergoing transcatheter atrial septal defect (ASD) closure with the Amplatzer septal occluder between May 2003 and April 2010.
Compared outcomes between a TEE-guided group (n=237, median age 24.2 years, all under general anesthesia) and an ICE-guided group (n=323, median age 30.5 years).
High procedural success without significant complications was achieved in 236 of 237 patients (99.6%) in the TEE group and 321 of 323 patients (99.4%) in the ICE group.
Surgical rescue occurred in 1 TEE patient due to device migration, and in 2 ICE patients due to mitral valve encroachment (n=1) and device embolization (n=1).
Total procedure time was significantly shorter in the ICE group compared to the TEE group (87.7 min vs 104.2 min, P<0.001).

Study Design

Type

Cohort (n=560)

Multicenter

Structured PICO

Population

560 patients aged 7 months to 75 years undergoing transcatheter closure of secundum atrial septal defect, evaluated retrospectively to compare ICE versus TEE guidance.

Exposure

Intracardiac echocardiography (ICE) guidance using an 8-Fr ultrasound catheter.

Comparator

Trans-esophageal echocardiography (TEE) guidance performed under general anesthesia with endotracheal intubation.

Outcome

Clinical outcome, including procedure success, major complications, and procedure time.

Main Result

Absolute Event Rate: 67.7% vs 94.2%

p-value: p=<0.001

ICE guidance using an 8-Fr catheter is a safe and effective alternative to TEE for transcatheter ASD closure, offering significantly shorter procedure times and avoiding the need for general anesthesia.

Limitations

Retrospective study design
Historical control bias (TEE was used before June 2006, and ICE was used thereafter)
Single-center study
High cost of single-use ICE catheters
Retrospective design
Higher cost of single-use ICE catheter

Cite This Study

Kim et al. (2012) conducted a cohort in Secundum atrial septal defect (n=560). 8-Fr Intracardiac echocardiography (ICE) guidance vs. Trans-esophageal echocardiography (TEE) guidance was evaluated on Procedure time (minutes) (p=<0.001). 8-Fr intracardiac echocardiography guidance for transcatheter closure of atrial septal defects significantly reduced procedure time compared to trans-esophageal echocardiography (67.7 vs 94.2 minutes) while avoiding general anesthesia.

synapsesocial.com/papers/6a73049b37e644ec14388489 https://doi.org/10.1253/circj.cj-11-1286

Topics

Echocardiography

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Eight-French Intracardiac Echocardiography

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Eight-French Intracardiac Echocardiography

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

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