B-4 | ASD Device Closure in Patients Weighing 0-10kg from 2013-2023: Modified Delivery Techniques and Outcomes

ASD device closure in small patients can be technically challenging with limited published outcome data. Review of our institutional records for patients ≤10 kg, and comparative data for 10-15 kg, at time of attempted ASD device closure from 2013 - 2023 was performed. Over the study period 341 pediatric ASD device closures were done, median weight 16 kg (4.7-113). 58 patients had successful ASD device closure at weight ≤10 kg (median 8 kg, 4.7-10.0), median age 14 months (1.8-45). Ventilatory support for the procedure was baseline ventilator dependent (3/58, 5%), elective intubation (6/58, 10%), and moderate sedation (49/58, 84%). Echocardiographic guidance was transthoracic (TTE) (49/58, 84%) or transesophageal (9/58, 16%). TTE ASD median size 10 mm (range 4-18) with ASD size to weight ratio median 1.2 (0.4-2.4). LA disc size to total septal length ratio median 0.93 (0.53-1.23). Stop flow sizing of the defect was performed for 70% but total septal length was taken into consideration for device selection. Successful ASD device closure was achieved with Amplatzer Septal Occluder (40/58 69%), Amplatzer Cribriform (1/58, 2%), and the Gore Cardioform Septal Occluder (17/58, 29%). There was successful ASD closure with initial device selected (40/58, 69%), second device (13/58, 22%), and third device (4/58, 7%). Technical modifications were used including balloon assist technique, delivery sheath heat gun shaping, beveled tip creation and exchanging manufacturer sheath for a lower profile sheath. Procedural complications were defined as device embolization, arrhythmia, bleeding, thrombi, cardiac arrest, and death. The incidence in ≤10 kg group (10/58, 17%) was similar to the 10-15 kg group (16/104, 15%). ASD closure was unsuccessful with device embolization and retrieval in 2 patients <10 kg, one had surgical closure and the other had successful device closure at 14 kg. This cohort of patients are all alive at last follow up with no major complications related to device closure. ASD device closure in ≤10 kg can be technically challenging, but with thoughtful device selection and modified delivery technique, can be done successfully without significant increase in major procedural complications.