Long-term outcome of percutaneous closure of secundum-type atrial septal defects in adults

Aims: Transcatheter closure of the secundum-type atrial septal defect (ASD) is widely practised. We report complications and efficacy of percutaneous ASD closure in adults using the Amplatzer® ASD occluder and the Cardioseal/Starflex® device during long-term follow-up. Methods and results: Between 1996 and 2008 percutaneous ASD closure was performed in 133 patients (mean age 46.8±16.9 years; 36 men) by using the Amplatzer® device in 104 patients and the Cardioseal/Starflex® device in 29. During a mean follow-up of 3.4±2.8 years the occurrence of major complications was higher in patients with the Cardioseal/Starflex® compared to patients with the Amplatzer® devices (17.2 vs. 2.9%, log rank, P=0.005), due to a higher embolisation rate (13.8 vs. 1.0%, log rank, P=0.002). In univariable analysis, the implantation of a Cardioseal/Starflex® device (OR 6.0 (CI 1.4-25.2); P=0.01) and a larger device diameter (OR 1.1 (CI 1.0-1.2); P=0.04) were found to be predictors of the occurrence of major complications. Minor complications occurred in 10.5%, recurrent thromboembolism in 2.3% and residual shunting at six months was 13.9% without differences between devices. NYHA class improved from 1.8±0.6 before to 1.2±0.4 after closure (P<0.001) without differences between devices. Conclusions: During long-term follow-up, percutaneous ASD closure in adults is safe and effective when using the Amplatzer® device. Larger Cardioseal/Starflex® devices are related to a higher embolisation rate. Randomised trials are needed.