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Updated: Sep 16, 2025
07:41
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
3.8K
Clinical Outcomes for Closure of Iatrogenic Atrial Septal Defects Following Transseptal SAPIEN Mitral Valve-in-Valve
Andrew Morse1, Samir Kapadia2, Mackram Eleid3
1Structural Heart & Heart Valve Clinic, Ascension Saint Thomas Heart West, Nashville, Tennessee.
Summary
Closing iatrogenic atrial septal defects (iASD) during transseptal mitral valve-in-valve (MViV) procedures is safe but offers no clinical benefit. Patients with severe pulmonary hypertension may experience harm from iASD closure.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Iatrogenic atrial septal defects (iASD) are common during transseptal (TS) mitral valve-in-valve (MViV) procedures.
- The clinical implications of leaving iASD untreated versus closure are not well-established.
Purpose of the Study:
- To evaluate the outcomes of concomitant iASD closure during TS MViV implantation.
Main Methods:
- Retrospective analysis of TS MViV patients receiving SAPIEN 3/Ultra/Resilia valves (June 2015-September 2023).
- Propensity score matching was used to compare patients with and without iASD closure.
- Evaluated procedural success, complications, and 1-year clinical outcomes.
Main Results:
- Among 5363 TS MViV patients, 8.8% underwent iASD closure.
- No significant differences in procedural success, stroke, or mortality were observed between groups after matching.
- Patients with severe pulmonary hypertension showed increased 30-day mortality and 1-year cardiac readmission with iASD closure.
Conclusions:
- Concomitant iASD closure during TS MViV is generally safe in selected patients.
- No significant clinical benefit was observed for iASD closure in the overall cohort.
- iASD closure may be detrimental in patients with severe pulmonary hypertension.
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