Erosion and embolization after transcatheter atrial septal defect closure: Findings from a multicenter international...

Percutaneous atrial septal defect (ASD) closure is an established alternative to surgical repair for patients with secundum ASD, offering minimally invasive treatment with high procedural success rates. Despite its widespread adoption, clinically significant complications such as device embolization and erosion may occur. Our Survey aims at providing a comprehensive, multicenter perspective on the incidence, features, and management strategies for these complications, in order to improve procedural outcomes and patient safety through collaborative data collection.

This is an international, multicenter survey collecting retrospective data from 30 centers performing transcatheter ASD closures between 2011 and 2021. Participating institutions contributed anonymous aggregate data on patient demographics, procedural details, and clinical outcomes, focusing on the incidence, anatomical and procedural risk factors, and management of device embolization or erosion.

A total of 30 institutions participated, providing data on 13.155 procedures of transcatheter closure of ASD, with 40% of them in children. Amplatzer device was used in 58% of cases, with balloon sizing performed routinely in 62% of institutions, mainly with stop flow technique. A total of 17 erosions (0.13%) were reported, of which 10 in children (incidence 0.19%) and 7 in adults (incidence 0.09%). Surgical repair was performed in all these cases, one patient died. Embolizations were reported in 91 cases (incidence 0.7%), with 60% of them in children. Most (80%) occurred within 24 h. Surgical retrieval was carried out in 29% of cases. Irrespective of management, no fatal complications occurred.

Complications such as embolization and erosion after transcatheter ASD closure in children and adults are exceedingly rare but still present in clinical practice and require careful monitoring for prompt recognition and timely intervention, in order to obtain favorable outcomes.