Closure of Iatrogenic Atrial Septal Defect After Transcatheter Mitral Valve Repair

Lurz, Philipp; Unterhuber, Matthias; Rommel, Karl‐Philipp; Kresoja, Karl‐Patrik; Kister, Tobias; Besler, Christian; Fengler, Karl; Sandri, Monica; Daehnert, Ingo; Thiele, Holger; Roeder, Maximilian von; Blazek, Stephan

doi:10.1161/circulationaha.120.051989

Cited by 29 publications

(18 citation statements)

References 5 publications

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“…There are limited data on iASD closure. Although our patient did not have persistent iASD, the recently published MITHRAS (A Randomized Trial of ASD Closure After IMVr) study prospectively randomized patients with persistent iASDs at 1-month post-procedure with a Qp:Qs ≥1.3 ( 9 ). The investigators found no difference in the primary endpoint of change in 6 min walking distance.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Atrial Septal Defect Closure Following Mitral Transcatheter Edge-to-Edge Repair

et al. 2021

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Transcatheter edge-to-edge repair has revolutionized the management of mitral regurgitation in the high surgical-risk population. Iatrogenic atrial septal defects (iASDs) are an obligatory consequence of the procedure. The long-term sequelae of persistent iASDs are unknown but are believed to be dependent on their size, directionality of flow, and underlying hemodynamics. We discuss an uncommon scenario of a post–transcatheter edge-to-edge repair iASD that required immediate closure. ( Level of Difficulty: Intermediate. )

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Section: Discussionmentioning

confidence: 99%

Iatrogenic Atrial Septal Defect Closure Following Mitral Transcatheter Edge-to-Edge Repair

et al. 2021

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“…In one study, persistent iASD was associated with a worse prognosis 9 . In the other one, closure of iASD after PMVR was not associated with any improvement in the clinical outcome, compared to conservative therapy 10 . In summary, available data about the impact of persistent iASD on clinical and echocardiographic outcomes is still scarce and inconclusive 11 .…”

Section: Introductionmentioning

confidence: 77%

“…In a prospective study of 66 patients, Schueler and colleagues demonstrated in a that persistent iASD at 6 months follow-up was associated with a worse clinical outcome and with an increased mortality 9 . Controversially, in a prospective study of 80 patients, Larz et al showed no significant improvement in clinical outcome in patients who received an interventional closure of persistent iASD after MitraClip compared to conservative therapy 10 . However, and as mentioned by both authors, this data must be interpreted with caution due to relatively short duration of follow up.…”

Section: Discussionmentioning

confidence: 99%

“…Use of transseptal access results in an iASD 16 . The incidence and impact of persistent iASD after PMVR on clinical and echocardiographic outcome were investigated in some studies 5 – 10 . However, the results were diverse and inconclusive 11 .…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of persistent iASD was previously investigated 5 – 8 . The clinical relevance of persistent iASD was evaluated in two prospective studies 9 , 10 . However, the results of both studies were diverse.…”

Section: Introductionmentioning

confidence: 99%

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Incidence and clinical relevance of persistent iatrogenic atrial septal defect after percutaneous mitral valve repair

Alachkar

Alnaimi

Reith

et al. 2021

Sci Rep

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Percutaneous mitral valve repair (PMVR) requires transseptal puncture and results in iatrogenic atrial septal defect (iASD). The impact of persistent iASD was previously investigated. However, data were diverse and inconclusive. 53 patients who underwent MITRACLIP were retrospectively included. Based on the presence of iASD in transesophageal echocardiography (TEE) after 6 months, patients were divided in two groups (iASD group vs. non-iASD group). Impact of iASD on outcome at 6 months and at two years was evaluated. Persistent iASD was detected in 62% of patients. Independent predictors for persistent iASD were female gender and reduced left ventricular ejection fraction. At 6-month follow-up, there was no difference in reduction of NYHA class (ΔNYHA = 1.3 ± 1 in iASD group vs. 0.9 ± 1 in non-iASD group, p = 0.171). There was a significant difference in right ventricular end diastolic diameter (RVEDd) (42 ± 8 mm in iASD-group vs. 39 ± 4 mm in non-iASD group, p = 0.047). However, right ventricular systolic function (TAPSE) (14 ± 7 mm in iASD group vs. 16 ± 8 mm in non-iASD group, p = 0.176) and right ventricular systolic pressure (RVSP) (40 ± 12 mmHg in iASD group vs. 35 ± 10 mmHg in non-iASD group, p = 0.136) were still comparable between both groups. At 2 years follow-up, there was no significant difference regarding rate of rehospitalization (24% vs 15%, p = 0.425) or mortality (12% vs 10%, p = 0.941) between both groups. Incidence of persistent iASD after MITRACLIP is markedly high. Despite the increase in right ventricular diameter in patients with persistent iASD, these patients were not clinically compromised compared to patients without persistent iASD.

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Management of Iatrogenic Interatrial Septal Defect—To Close or not to Close?

Tan¹,

McCabe²

2021

Transcatheter Mitral Valve Therapies

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Closure of Iatrogenic Atrial Septal Defect After Transcatheter Mitral Valve Repair

Cited by 29 publications

References 5 publications

Iatrogenic Atrial Septal Defect Closure Following Mitral Transcatheter Edge-to-Edge Repair

Iatrogenic Atrial Septal Defect Closure Following Mitral Transcatheter Edge-to-Edge Repair

Incidence and clinical relevance of persistent iatrogenic atrial septal defect after percutaneous mitral valve repair

Management of Iatrogenic Interatrial Septal Defect—To Close or not to Close?

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