Risk factors for prolonged intensive care treatment following atrial septal defect closure in adults

Hörer, J.; Eicken, Andreas; Müller, Stefan; Schreiber, Christian; Cleuziou, Julie; Prodán, Zsolt; Holper, K; Lange, Rüdiger

doi:10.1016/j.ijcard.2007.02.022

Cited by 13 publications

(11 citation statements)

References 16 publications

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“…First, elder patients with ASD acquire comorbid conditions include arrhythmia, hypertension, respiratory distress, kidney disease, etc. that always play a significant role in their heart conditions [4,9]. Second, elder ASD patients may have inherently superior resilience, milder disease, or balanced physiology in contrast to those not surviving to an advanced age.…”

Section: Clinical Feature Of Asd In Various Aged Populationsmentioning

confidence: 99%

“…It is well known that the natural course in patients with ASD and pulmonary hypertension is significantly worse than in patients without pulmonary hypertension [2]. Thus, closure of ASD in patients with pulmonary hypertension was considered as a high-risk procedure, especially with surgical closure [9]. However, transcatheter closure without cardiopulmonary bypass can be performed even in such high-risk patients, and several clinical studies have demonstrated the efficacy and safety of ASD closure [33,34].…”

Section: Pulmonary Arterial Hypertension and Asdmentioning

confidence: 99%

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Current concept of transcatheter closure of atrial septal defect in adults

Akagi

2015

Journal of Cardiology

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After the introduction of catheter intervention for atrial septal defect (ASD) in the pediatric population, therapeutic advantages of this less invasive procedure were focused on adult through geriatric populations. The most valuable clinical benefits of this procedure are the significant improvement of symptoms and daily activities, which result from the closure of left to right shunt without thoracotomy and cardiopulmonary bypass surgery. These benefits contribute to increase the number of adult patients of this condition who have hesitated over surgical closure. In terms of technical point of view for catheter closure of ASD, the difficulties still exist in some morphological features of defect, or hemodynamic features in the adult population. Morphological features of difficult ASD closure are (1) large (≥30 mm) ASD, (2) wide rim deficiency, and (3) multiple defects. Hemodynamic features of difficult ASD are (1) severe pulmonary hypertension, (2) ventricular dysfunction, and (3) restrictive left ventricular compliance (diastolic dysfunction) after ASD closure. To complete the catheter ASD closure under these difficult conditions, various procedural techniques have been introduced. These are new imaging modalities such as real-time three-dimensional imaging, new technical modifications, and new concepts for hemodynamic evaluation. Especially, real-time three-dimensional transesophageal echocardiography can provide the high quality imaging for anatomical evaluation including maximum defect size, surrounding rim morphology, and the relationship between device and septal rim. In adult patients, optimal management for their comorbidities is an important issue, which includes cardiac function, atrial arrhythmias, respiratory function, and renal function. Management of atrial arrhythmias is a key issue for the long-term outcome in adult patients. Because the interventional procedures are not complication-free techniques, the establishment of a surgical back-up system is essential for the safe achievement of the procedure. Finally, the establishment of a team approach including pediatric and adult cardiologists, cardiac surgeons, and anesthesiologists is the most important factor for a good therapeutic outcome.

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Section: Clinical Feature Of Asd In Various Aged Populationsmentioning

confidence: 99%

Section: Pulmonary Arterial Hypertension and Asdmentioning

confidence: 99%

Current concept of transcatheter closure of atrial septal defect in adults

Akagi

2015

Journal of Cardiology

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“…The consequence of such changes has been observed to be reversible in younger patients, but may not be fully reversible in the elderly [116] . It is well understood that the natural course of ASD and the associated effect on pulmonary hypertension is notably worse than in patients without pulmonary hypertension [117] . Thus, pulmonary hypertension is traditionally considered an absolute contraindication to ASD intervention, especially surgical closure [118] .…”

Section: Asd and Pulmonary Arterial Hypertensionmentioning

confidence: 99%

Atrial septal defect repair in the age of transcatheter devices

Zimmermann¹,

Hussain²,

Worku³

et al. 2019

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The aim of this review is to discuss the management of atrial septal defects (ASD) in the adult patient paying special attention to the elderly population and the most recent transcatheter advancements. ASDs are characterized by the following categories: ostium secundum, ostium primum, sinus venosus, and coronary sinus defects; though multiple defects may exist concurrently. Intervention for closure of ASDs are indicated with the development of right ventricular volume overload, or in the clinical context of paradoxical embolic stroke. Previously, there was significant disagreement regarding the timing of ASD closure in adult patients, but there is now general consensus that adult patients with clinical evidence of right ventricular overload should undergo closure of ASDs at the time of presentation. The present review describes the typical presentation of patients with symptomatic ASD's, medical management, and whether surgical or percutaneous approach should be pursued. We will also discuss other important considerations for patient selection and potential early and late complications of transcatheter ASD closure such as congestive heart failure, device embolization, and tissue erosion. At the time of this writing, there are currently three FDA-approved devices for percutaneous VSD closure including the Amplatzer TM Septal Occluder (ASO, St. Jude Medical, St. Paul, MN), Gore HELEX TM Septal Occluder (W.L. Gore and Associates, Newark, NJ), and Gore CARDIOFORM TM Septal occluder (GCSO, W.L. Gore and Associates, Newark, NJ) devices. Many premarket approvals were granted for devices that never went to market due to poor investigational study performance. Likewise, the HELEX device has since been discontinued upon bringing the GCSO device to market. We will focus primarily on the ASO device with a brief review of current investigations into the GCSO device, both of which carry an indication for closure small to medium sized ASDs in the ostium secundum position. Additionally, this review covers the safety of transcatheter closure of ASDs with currently available devices, review studies associated with devices available outside the United States, and perioperative considerations for transcatheter Page 2 of 18 Zimmermann et al. Vessel Plus 2019;3:31 I http://dx.intervention. Obstacles to device employment and countermeasures to overcome operational challenges will also be discussed. To this end, variations or similarities of currently approved devices will be emphasized throughout this discussion where possible. Lastly, we will offer insights into device evolution trends with the expectation of new device developments on the horizon. We will briefly discuss up and coming areas of active research, including the emerging fields of novel biomaterials and gene therapy. MORPHOLOGY AND CLINICAL FEATURES OF ASDS Location, Morphology, and suitability for surgery vs. transcatheter interventionIt is important to note that morphological variations of different types of ASDs, which determines whether a particular defect is amenabl...

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“…We assumed that there might be no severe ASD patients in our study, who usually die or who undergo intervention at a young age. 3 , 4 In addition, because several comorbidities always play a significant role in the severity of heart condition in adult ASD patients, 33 propensity score matching was used for advanced participant-selection to ensure no significant disparity in follow-up time and baseline characteristics between surgical or transcatheter intervention. Furthermore, we excluded any patient accepted combined SC of ASD with other cardiac surgery, such as valve replacement/revision to prevent more complicity of ASD structure in SC group than those in TC group.…”

Section: Limitationsmentioning

confidence: 99%