Key Points
- To evaluate the initial two-year clinical experience, safety, and complications of anesthetic management during transcatheter closure of atrial septal defects using a double-umbrella device.
- Analyzed 122 consecutive transcatheter atrial septal defect repair procedures, comprising 118 primary anesthetic cases and 4 urgent anesthetic interventions over a two-year period.
- Evaluated hemodynamic stability, airway outcomes, and complications between spontaneous ventilation (intravenous ketamine and midazolam) and general endotracheal anesthesia with neuromuscular blockade.
- Spontaneous ventilation was maintained in 77% of cases (n=93/122) with a mean maximum PaCO2 of 41 ± 6 mm Hg, whereas 23% (n=29/122) required tracheal intubation and paralysis.
- Anesthetic complications developed in three patients (two ventilatory compromise events under spontaneous breathing and one intraoperative awareness during endotracheal anesthesia), with zero procedural mortality.
- Procedural complications requiring anesthetic adaptation included six device embolizations (two requiring open surgical retrieval), four intracardiac air embolisms, and three transient brachial plexus injuries.
Structured PICO
What are the anesthetic and procedural complications associated with transcatheter closure of atrial septal defects?
PPopulation122 cases of patients undergoing transcatheter closure of atrial septal defects using a double-umbrella (clamshell) device.
IInterventionAnesthetic care, including spontaneous ventilation with intravenous ketamine and midazolam or tracheal intubation with muscle paralysis.
OOutcomeAnesthetic-related and procedural complications.safety
General anesthesia with spontaneous ventilation using ketamine and midazolam is generally safe and effective for transcatheter ASD closure, though tracheal intubation is sometimes necessary for safety and optimal operating conditions.