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Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Closure of Interatrial Septal Communications: Adverse Events and Lessons Learned
1HerzZentrum Hirslanden, Witellikerstrasse 36, 8008 Zurich, Switzerland.
Insights
A new classification for adverse events (AE) in percutaneous closure of interatrial septal communications (IASC) is proposed. This standardized approach aids in comparing IASC safety and identifying preventable complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Percutaneous closure of interatrial septal communications (IASC) is a common procedure.
- Standardized reporting and classification of adverse events (AE) are lacking for IASC.
- Previous studies have not focused on AE and their prevention strategies.
Purpose of the Study:
- To propose a standardized classification for AE in IASC.
- To evaluate the incidence of major AE using a novel classification system.
- To identify potential strategies for AE avoidance in IASC.
Main Methods:
- Retrospective review of 112 consecutive IASC cases performed by a single operator.
- AE classification adapted from percutaneous coronary intervention (PCI) standards.
- Detailed review of each AE and potential avoidance measures.
Main Results:
- Major AE occurred in 2.7% of patients under the proposed classification.
- AE included cardiac tamponade, device embolization requiring retrieval, and arteriovenous fistula requiring surgical treatment.
- Two of three major AE might have been preventable with improved patient and device selection.
Conclusions:
- The proposed AE classification offers a unified and comparable method for IASC procedures.
- Standardized AE reporting is crucial for improving IASC safety.
- Careful patient and material selection can potentially reduce major AE in IASC.
Background:
Percutaneous closure of interatrial septal communications (IASC) is generally being regarded as a safe and straightforward intervention. Reporting and classification of adverse events (AE) as is the case for percutaneous coronary intervention (PCI) is not standardized. Also, the focus of reported larger studies has not been primarily on AE and strategies to avoid them.
Methods:
The data of all 112 consecutive patients undergoing IASC by a single operator were reviewed. In analogy to classification for PCI, an AE was considered to be major if any of the following occurred: death, major or minor stroke, myocardial infarction, the need for an originally unplanned additional surgery or intervention or blood transfusion. Every AE and how it may have been avoided is reviewed in detail.
Results:
Major AE according to the suggested classification occurred in 2.7% of patients, including tamponade in 1 patient necessitating thoracotomy 7 months after IASC, percutaneous retrieval of an embolized device in 1 patient, and ambulatory same day surgical treatment of an arteriovenous fistula in 1 patient.
Conclusions:
The proposed new classification of AE provides a unified and comparable approach for IASC procedures. Retrospectively, two of the 3 major AE could have probably been avoided by more thoughtful patient and material selection.
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