Single tertiary center experience using Gore Cardioform Atrial Septal Defect Occluder for secundum atrial septal
Subhrajit Lahiri1, Athar M Qureshi2, Ricardo H Pignatelli2
1Children's Hospital of Illinois, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA.
Insights
Transcatheter closure of atrial septal defects (ASDs) using the Gore Cardioform Septal Occluder is feasible even with deficient rims. However, large ASDs with specific deficient rims (posterior, posterosuperior, and inferior) are linked to lower success rates.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Limited data exists on using the Gore Cardioform Septal Occluder (GCA) for atrial septal defects (ASDs) with deficient rims.
- Deficient rims pose a challenge for successful transcatheter closure.
Purpose of the Study:
- To evaluate the feasibility and outcomes of transcatheter closure of ASDs with deficient rims using the GCA.
- To identify factors associated with procedural success or failure.
Main Methods:
- Retrospective analysis of patients undergoing transesophageal echocardiogram (TEE) for ASD occlusion.
- Assessment of various ASD rim dimensions (anterior-superior, posterior, anterior-inferior, posterior-superior, superior, inferior) using TEE.
- Definition of large ASDs (>20 mm) and deficient rims (<5 mm).
Main Results:
- In 148 patients, 75.7% had at least one deficient rim.
- Transcatheter closure was performed in 115 patients, with a 96.5% success rate.
- Multiple deficient rims, and specifically posterior, posterosuperior, and inferior deficient rims, were associated with unsuccessful closure.
Conclusions:
- Transcatheter closure of ASDs with deficient rims is feasible with the GCA.
- Large ASDs with deficient posterior, posterosuperior, and inferior rims are associated with unsuccessful closure.
- Thorough pre-procedural evaluation of ASD rim characteristics is crucial for optimal GCA use.
Background:
The data on the use of Gore Cardioform Septal Occluder (GCA; W. L. Gore and Associates, Inc.) for atrial septal defect (ASD) with deficient rims is limited.
Methods:
All patients evaluated by transesophageal echocardiogram (TEE) for ASD occlusion were included. TEE planes at 35°, 0°, and 90° were assessed for anterior-superior (AS) and posterior (P), anterior-inferior (AI) and posterior-superior (PS), as well as superior (S) and inferior (I) rims. ASD size >20 mm, and rims less than 5 mm were defined as large and deficient, respectively. We included patients who had a procedural failure along with the patients in whom the procedure was not attempted after echocardiogram in the unsuccessful group.
Results:
In 148 patients, the median weight, age, and ASD size were 36 kg (range, 8-60 kg), 11.8 years (range, 1-60 years), and 14.2 ± 8.28 mm, respectively. One or more deficient rims were noted in 112 of 148 (75.7%): 99 (67%) AS, 36 (24%) P, 17 (11%) AI, 30 (20%) PS, 26 (18%) S, and 33 (22%) I. ASD closure was performed in 115 (78%) patients. The procedure was successful in 111 (96.5%) patients with procedural failure in 4 (3.4%) patients. Multiple deficient rims were associated with reduced procedural success (OR 0.36, 95% CI, 0.25-0.56). On multivariate analysis deficient P, PS, and I rims were associated with an unsuccessful group (P = .001, .046, and .005, respectively). Complications included 1 device embolization, 1 vascular injury, and 5 arrhythmias.
Conclusions:
Transcatheter closure of ASDs with deficient rims is feasible using GCA. Large ASDs with deficient P, PS, and I rims were associated with unsuccessful closure. Risk stratification and comprehensive evaluation of ASD rims is vital for the use of GCA.
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