Key result
Implantation of a wire frame occluder for atrial septal defect resulted in a significantly greater increase in BNP levels at 1 month (ratio of change 1.36) and a lower early prevalence of residual shunt compared to metal mesh devices.
Why the study?
Transcatheter ASD closure is the first treatment option for secundum ASD, but parameters for optimal device selection have not been established.
Does a wire frame occluder compared to metal mesh devices improve residual shunt and BNP levels in patients undergoing transcatheter ASD closure?
Cohort (n=970)
No
Does a wire frame occluder compared to metal mesh devices improve residual shunt and BNP levels in patients undergoing transcatheter ASD closure?
Effect estimate: ratio of change 1.36 (95% CI 1.01-1.83)
Absolute Event Rate: 87.9% vs 38.4%
p-value: p=0.045
Wire frame occluders for ASD closure result in earlier complete occlusion but cause a greater transient increase in BNP levels at 1 month compared to metal mesh devices, suggesting early left-sided cardiac overload.
Wire frame ASD occluders were associated with fewer early residual shunts but greater BNP rise; leaves open optimal device selection pending prospective trials.
BACKGROUND: Transcatheter atrial septal defect (ASD) closure is the first treatment option for secundum ASD, but parameters for optimal device selection have not been established. We compared outcomes between occluders with a wire frame and metal mesh devices. METHODS AND RESULTS: CARDIOFORM ASD occluder [GCA]; W.L. Gore & Associates) or metal mesh devices (Amplatzer septal occluder device [Abbott] and Occlutech Figulla Flex II device [Occlutech]). The presence of residual shunt and B-type natriuretic peptide (BNP) levels after implantation were compared. Of the 970 patients with either GCA (n=48) or a metal mesh device (n=922; control), 42 patients from each group were analyzed after propensity score matching. The prevalence of residual shunt was significantly lower in the GCA group 1 day and 1 month after implantation (P<0.001 and P=0.017, respectively), whereas there was no significant difference between the 2 groups 6 months later (P=0.088). BNP levels at 1 month were significantly higher in the GCA group (ratio of change 1.36; 95% confidence interval [CI] 1.01-1.83), but did not differ significantly between the 2 groups at 6 months (ratio of change 1.04; 95% CI 0.65-1.65). CONCLUSIONS: Patients implanted with a wire frame occluder had a lower prevalence of residual shunt and a greater increase in BNP levels in the early period after implantation.
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Nakashima et al. (2025) conducted a cohort in Secundum atrial septal defect (n=970). GORE CARDIOFORM ASD occluder (GCA) vs. Conventional metal mesh devices (Amplatzer septal occluder and Occlutech Figulla Flex II) was evaluated on Percentage change in B-type natriuretic peptide (BNP) levels at 1 month (ratio of change 1.36, 95% CI 1.01-1.83, p=0.045). Implantation of a wire frame occluder for atrial septal defect resulted in a significantly greater increase in BNP levels at 1 month (ratio of change 1.36) and a lower early prevalence of residual shunt compared to metal mesh devices.
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