Key result
Transcatheter ASD closure achieves ~89% 6-month composite clinical success in real-world cohort.
Why the study?
Atrial septal defect device closure is routine, but clinical success and long-term outcomes are often overlooked.
Cohort (n=400)
No
Answers are grounded in this paper and cite their sources.
Transcatheter ASD closure demonstrates high long-term clinical and closure success rates with low serious adverse events, though interventions requiring advanced technical maneuvers like balloon or guidewire assistance carry a higher risk of composite clinical failure.
BACKGROUND: Atrial septal defect device closure is routine, yet clinical success and long-term outcomes are often overlooked. We aim to identify predictive factors for failure and describe long-term outcomes. METHODS: A single-center retrospective review (2006-2021) of 400 patients undergoing transcatheter atrial septal defect closure was conducted. Primary end point was 6-month composite clinical success, including technical success (implantation and device retention), closure success (trivial/no residual shunt), absence of 30-day serious adverse events, and no device removal/reintervention. Secondary end points were technical success, procedure success (technical success with less than moderate residual shunt), closure success (clinically insignificant/absent residual shunt), and safety. RESULTS: The cohort included 43.2% males, with a median age of 14.5 years [Q1-Q3: 8.3-37] and weight of 47.5 kg [25-68]. At baseline, the median stop-flow defect diameter was 24 mm [18.9-29]; 22.3% had a diameter ≥30 mm, 4.9% had a diameter-to-weight ratio of 1.5-1.8, 17.7% were multi-fenestrated, 39.3% had margin deficiency, and 10.7% had an atrial septal aneurysm. A single device was used in 98.8% of procedures (75.7% Amplatzer, 23.0% Occlutech). Median difference between device size and balloon-sizing diameter was 1 mm [0-2]. Implantations were pulmonary vein-assisted in 26.8%, guidewire-assisted in 2.5%, and balloon-assisted in 3.8%. Technical success at hospital discharge was 95.8%, and procedural success was 94.8%. Closure success was 98.7% (377/382) at 6 months and 98.9% (193/194) at 96 months. Freedom from SAEs was 95.5% at 30 days. Freedom from device events was 97.4% at 6 months. Six-month composite clinical success rate was 89.3%. Balloon-assisted implantation (odds ratio [OR], 4.494, [95% CI 1.471-13.729]), guidewire-assisted implantation (OR 6.559 [95% CI 1.759-24.454]), and smaller device-to-balloon sizing difference (OR 0.8000 [95% CI 0.663-0.967]) were independent predictors of failure. CONCLUSIONS: Transcatheter atrial septal defect closure shows high success, with balloon- and guidewire-assisted implantations and smaller device-to-balloon-sizing differences as predictors of clinical failure.
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Saliba et al. (2025) conducted a cohort in Atrial septal defect (n=400). Transcatheter atrial septal defect closure was evaluated on 6-month composite clinical success (technical success, closure success, no 30-day serious adverse events, and no device removal/reintervention). Transcatheter atrial septal defect closure achieved an 89.3% 6-month composite clinical success rate, while advanced implantation techniques and smaller sizing differences predicted clinical failure.
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