Key result
Transcatheter closure of ventricular septal defects resulted in a 5-year event-free survival of 61%, with cardiogenic shock (HR 3.21; 95% CI 1.82-5.41; P=0.002) predicting adverse events.
Cohort (n=27)
No
Transcatheter closure of post-MI VSD carries a moderate risk of periprocedural complications but low event rates thereafter, with cardiogenic shock and acute phase closure being independent predictors of adverse events.
Warrants caution in cardiogenic shock for transcatheter post-MI VSD closure; leaves open need for randomized trials versus surgery.
OBJECTIVES: To determine event-free survival after transcatheter closure of ventricular septal defect (VSD), and to identify predictors of adverse events (AE) in post myocardial infarction VSD (post-MI VSD) subgroup. BACKGROUND: There are limited data on mid-term follow-up after transcatheter VSD closure. METHODS: Retrospective review of 27 cases of transcatheter VSD closure (post-MI = 18 and non-ischemic = 9) performed from 1999 to 2013. We defined AE as death, device embolization, hemolysis requiring blood transfusion, heart block and reintervention. RESULTS: In the post-MI VSD subgroup, mean age and follow-up was 69 ± 11 and 7.3 ± 7 years, respectively. AE occurred in 8 (44%) patients (death-3, device embolization-1, hemolysis-1, surgical VSD closure-2, reintervention-1). Event-free survival was 56% at 1 month and 5 years, and all AE occurred in the periprocedural period. Cardiogenic shock (HR: 3.21, CI: 1.82-5.41, P = 0.002), and VSD closure in acute phase (HR: 2.14, CI: 1.12-4.31, P = 0.004) were independent predictors of AE. In the non-ischemic VSD subgroup, mean age and follow-up was 49 ± 15 and 8.7 ± 8 years, respectively. AE occurred in 3 (33%) patients (late death-1, surgical VSD closure-2). For the entire cohort, freedom from death was 89% and 85% at 1 month and 5 years, and event-free survival was 70% and 61% at 1 month and 5 years. CONCLUSIONS: Transcatheter closure of post-MI VSD carries a moderate risk of periprocedural complications but low event rates afterwards. By comparison, device closure of non-ischemic VSD has lower periprocedural morbidity but some patients continued to experience AE during follow-up.
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Egbe et al. (2015) conducted a cohort in Ventricular septal defect (n=27). Transcatheter VSD closure was evaluated on Event-free survival at 5 years. Transcatheter closure of ventricular septal defects resulted in a 5-year event-free survival of 61%, with cardiogenic shock (HR 3.21; 95% CI 1.82-5.41; P=0.002) predicting adverse events.
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