Predictors of Atrial Septal Defect Occluder Dislodgement

Lee, Wei‐Chieh; Fang, Chih-Yuan; Huang, Chien-Fu; Lin, Ying-Jui; Wu, Chiung‐Jen; Fang, Hsiu‐Yu

doi:10.1536/ihj.15-065

Cited by 19 publications

(5 citation statements)

References 20 publications

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“…The other advantage of the technology in our method was the ‘left atrium-occluder-the right atrium’ suture through Waterston’s groove, which can fix the occluder where the transcatheter approach cannot reach. According to the reports in the literature and clinical observation, occluder dislodgement or embolization was a catastrophic complication in the device closure procedure, and the deficient rims were a major cause of the unsuccessful device procedural outcomes [ 25 , 26 ]. Through such additional stitching, the occluder could be firmly fixed in its position in the case of its dislodgement or embolization.…”

Section: Discussionmentioning

confidence: 99%

Midterm follow-up of transthoracic device closure of an atrial septal defect using the very large domestic occluder (44–48 mm), a single Chinese cardiac center experience

Chen

Cao

Zhang

et al. 2017

J Cardiothorac Surg

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BackgroundThe purpose of this study was to outline the midterm follow-up results and complications in patients who underwent transthoracic device closure of an atrial septal defect (ASD) with the very large domestic occluder (44–48 mm).MethodsThe data of 35 patients who underwent transthoracic device closure of an ASD with the very large domestic occluder (44–48 mm) at our institution were collected prospectively between January 2010 and January 2015. All patients were invited for an outpatient visit and contrast TTE for 12–70 months after ASD closure.ResultsThirty-four patients were occluded successfully under this approach and 1 patient was transferred for surgical repair for dislodgement of the occluder. The most frequent complication was transient cardiac arrhythmia. A new third degree atrioventricular block occurred in 1 patient who recovered 1 week later. During the follow-up period, we found no recurrence, no thrombosis, no device embolization, no device failure, and no cases of death. The total occlusion rate was 94.1% in the 12 months of follow-up, and the intracardiac structure and cardiac function were significant improved contemporaneously.ConclusionTransthoracic device closure of an atrial septal defect with the very large domestic occluder (44–48 mm) is a safe and feasible technique. However, long-term follow-up is required to better assess the safety and feasibility of this method for the closure of very large ASDs in patients.

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Section: Discussionmentioning

confidence: 99%

Midterm follow-up of transthoracic device closure of an atrial septal defect using the very large domestic occluder (44–48 mm), a single Chinese cardiac center experience

Chen

Cao

Zhang

et al. 2017

J Cardiothorac Surg

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“…The commonest reasons for occluder dislodgement are the use of an undersized ASD device, greater defect size, left atrium too small to accommodate the device, an inadequate or floppy rim, device mobility postimplantation, and operator-related technical issues (44). The most of dislodgement occurs within 24 hours post implantation and takes place into left atrium (24.6%), aorta (18.4%), and right ventricle (16.7%) (45,46). The majority of the devices can be retrieved percutaneously after early embolization.…”

Section: Complicationsmentioning

confidence: 99%

Atrial septal defect (ASD) device trans-catheter closure: limitations

Faccini¹,

Butera²

2018

J. Thorac. Dis.

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Systematic reviewTranscatheter closure is a widespread technique used to treat secundum atrial septal defects (ASDs). When compared to surgery, it provides a less invasive approach with quicker recovery and reduced physical and psychological impact (1-4).The first case was performed in 1976 by King and Mills (5). However, the percutaneous ASD closure fully entered the clinical arena with the introduction of Amplatzer septal occluder devices (ASO) (6). Since then, many other devices have been developed and used, such as the Gore Cardioform septal occluder (GSO), the Figulla Flexible Occlutech device, the Cardioseal/Starflex and the bio absorbable devices Biostar or Biotrek (7,8).Nowadays, almost 85-90% of all secundum ASD can be closed by using a transcatheter approach (9,10). However, several limitations may have a significant impact on the feasibility and success of percutaneous ASD closure (11,12).Limitations can be grouped as follows: (I) anatomical limitations; (II) device-related limitations; (III) associated defects and natural history associated issues; (IV) physiological limitations; (V) complications. Anatomical limitationsA common underlying structure apply to all available devices: they are made of two disks and a connecting segment that keeps them together across the ASD. Two different engineering concepts have been developed, so that occluder devices can be classified as self-centering and nonself-centering ones. The Amplatzer and the Amplatzer-like devices, in which a central connecting waist fills the defect improving stability and occlusion, belong to the former, while devices such as GSO, where the connecting segment is linear, belong to the latter. All the currently available devices need to have surrounding "walls" supporting their stability. In particular, the disks of non-self-centering ones should be 1.8-2 times the diameter of the defect in order to have complete defect closure and avoid mal position or embolization (8).Main anatomical limitations to percutaneous ASD closure may be insufficient surrounding rims, multiple defects and excessively bulging atrial septal aneurisms (ASA).Typical of ostium primum ASD and sinus venosus-type defects, deficiency of surrounding rims can affect ostium

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“…According to previous reports and clinical observations, occluder dislodgement or embolization is a rare but severe complication of device closure procedures [28]. Fortunately, only one patient in group A suffered occluder dislodgement in the perioperative period and underwent surgical repair.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter and intraoperative device closure and surgical repair for atrial septal defect

Qiu¹,

Chen²,

Hong³

et al. 2019

J Cardiothorac Surg

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Background Transcatheter and intraoperative device closure for atrial septal defect (ASD) are widely applied to reduce the incision size and the potential for injury during cardiopulmonary bypass (CPB) in conventional surgical repair. No studies had been conducted to compare the safety and efficiency of these three treatments. Methods From January 2018 to April 2018, 87 patients with an isolated ASD who had undergone transcatheter device closure ( n = 45), intraoperative device closure ( n = 22) and surgical repair ( n = 20) were retrospectively reviewed and further analyzed to compare these three treatments. Results The successful closure rate was similar in the three groups. There was a significant difference in aortic cross-clamping time, CPB duration and operative time between the surgical group and the device groups. The length of intensive care unit stay, postoperative mechanical ventilation time and length of hospital stay were shorter in the two device groups than in the surgical group. The incision was the most extended in the surgical group. Regarding major adverse events, no significant differences were found among the three groups. Conclusions Transcatheter and intraoperative device closure and surgical repair for ASD are all safe and effective. Considering their respective disadvantages and advantages, the transcatheter approach may be the first choice for an isolated secundum ASD, the intraoperative approach may be the second choice, and surgical repair may be the last resort.

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Predictors of Atrial Septal Defect Occluder Dislodgement

Cited by 19 publications

References 20 publications

Midterm follow-up of transthoracic device closure of an atrial septal defect using the very large domestic occluder (44–48 mm), a single Chinese cardiac center experience

Midterm follow-up of transthoracic device closure of an atrial septal defect using the very large domestic occluder (44–48 mm), a single Chinese cardiac center experience

Atrial septal defect (ASD) device trans-catheter closure: limitations

Transcatheter and intraoperative device closure and surgical repair for atrial septal defect

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