Related Experiment Video
Updated: Aug 8, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Transcatheter closure of large postinfarct ventricular septal defect: Initial results of prototype Occlutech® device
Kuo Ting Lee1, Demetris Taliotis2, Mark Hamilton3
1Department of Cardiology, Bristol Heart Institute, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Insights
Newer devices show promise for closing large postinfarct ventricular septal ruptures (VSR) when standard occluders fail. Further refinement is needed to improve survival rates in these complex cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Postinfarct ventricular septal rupture (VSR) is a severe complication with high mortality.
- Optimal treatment strategies for VSR remain unclear due to limited evidence.
- Existing percutaneous devices are often too small for large VSRs.
Purpose of the Study:
- To evaluate the feasibility and immediate outcomes of using a prototype 36mm occluder for large postinfarct VSRs.
- To assess the safety and efficacy of a novel device in patients unsuitable for standard treatment.
Main Methods:
- Six patients with large, complex postinfarct VSRs were treated with a prototype Occlutech® 36mm PI-VSD occluder.
- This included the first-in-human application of the device.
- Patients were considered unsuitable for existing approved occluders.
Main Results:
- Successful deployment of the prototype device in all six patients.
- Satisfactory immediate results with significant shunt reduction observed.
- However, 50% of patients in cardiogenic shock did not survive to discharge, with two cases experiencing device complications.
Conclusions:
- Percutaneous closure of large postinfarct VSRs is achievable with newer, wider-coverage devices.
- Device refinement is crucial to enhance treatment success and improve patient survival.
- Further research and larger trials are warranted.
Background:
Postinfarct ventricular septal rupture is a serious complication in delayed or failed reperfusion with a grim prognosis. The optimal timing and treatment option remain debatable in the absence of randomized controlled trials. Percutaneous device closure is a well-reported and less invasive treatment option but recent imaging studies indicate that majority of defects are too large to be adequately covered by the currently Conformite Europeenne and Food and Drug Administration approved occluder devices.
Methods:
Six patients presented with large and complex postinfarct ventricular septal ruptures, considered unsuitable for the Amplatzer post-infarct ventricular septal defect Occluder, so were treated using the prototype Occlutech® 36 mm PI-VSD occluder, including the first-in-human use.
Results:
The prototype device was successfully deployed in all patients with satisfactory immediate results and shunt reduction. Three patients (50%) in cardiogenic shock did not survive beyond discharge, of which two were complicated by device dislodgement or embolization.
Conclusions:
Percutaneous closure of large postinfarct ventricular septal ruptures is possible using newer device with a wider coverage. Further device refinement is necessary to improve treatment outcomes.
