Complications after percutaneous device closure of atrial septal defects in children: Prevalence, outcomes and
Michael N Gritti1,2, Olivia Carere1, Brian W McCrindle1,2
1Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Insights
Transcatheter closure of atrial septal defects (ASDs) in children is safe and effective, with low complication rates and excellent long-term outcomes. Neither congenital heart disease nor imaging technique impacted risk, supporting device closure as a reliable treatment.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Atrial septal defects (ASDs) constitute 10% of congenital heart disease (CHD).
- Transcatheter closure is standard for suitable ASDs, but pediatric long-term outcomes need further reporting.
- This study evaluates outcomes and complications of ASD device closure in children.
Purpose of the Study:
- To examine the prevalence and outcomes of transcatheter ASD closure in pediatric patients.
- To identify risk factors for complications following device closure for ASDs.
- To assess the long-term safety and efficacy of transcatheter ASD closure in children.
Main Methods:
- Retrospective review of 971 children (<18 years) undergoing transcatheter ASD closure (1989-2016).
- Analysis of demographic, procedural, and follow-up data.
- Kaplan-Meier methods used to assess freedom from major complications and associations with device type, imaging, and concomitant CHD.
Main Results:
- Major complications occurred in 1.6% of patients (device embolization, erosion, urgent surgery).
- Long-term freedom from major complications was high: 98.1% at 5 years and 97.6% at 10 years.
- No significant differences in complication rates were found based on imaging modality (ICE vs. TEE) or presence of concomitant CHD.
Conclusions:
- Transcatheter ASD closure demonstrates low complication rates and excellent long-term outcomes in a large pediatric cohort.
- Concomitant CHD and imaging technique did not significantly influence complication risk.
- These findings support the long-term safety and efficacy of device closure for ASDs in children.
Background:
Atrial septal defects (ASDs) represent 10% of congenital heart disease. Transcatheter closure is the standard of care for anatomically suitable defects, but pediatric long-term outcomes remain underreported. This study examined the prevalence, outcomes, and risk factors for complications following ASD device closure in children.
Methods:
We retrospectively reviewed children <18 years undergoing transcatheter ASD closure at a single tertiary center (1989-2016). Demographic, procedural, and follow-up data were analyzed. Kaplan-Meier methods assessed freedom from major complications and associations with device type, imaging technique, and concomitant congenital heart disease (CHD).
Results:
A total of 971 children (mean age 8.2 ± 4.2 years, 62% female) underwent closure, with median follow-up 2.2 years (maximum 20.7). Concomitant CHD was present in 33%. Major complications occurred in 1.6%, including device embolization (0.6%), erosion (0.4%), and urgent surgery (0.6%). Rates were highest with early-era devices (8%). Kaplan-Meier analysis showed freedom from major complications of 98.1% at 5 years and 97.6% at 10 years. No significant differences were observed by imaging modality (ICE vs. TEE) or presence of concomitant CHD.
Conclusions:
In this large pediatric cohort, transcatheter ASD closure was associated with low rates of major complications and excellent long-term outcomes. Neither concomitant CHD nor imaging technique significantly affected complication risk. These findings reinforce the long-term safety of ASD device closure in children.
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