Long-term outcomes after percutaneous closure of isolated secundum atrial septal defect in the young: A nationwide cohort study

Abstract

Transcatheter closure has become the preferred treatment strategy in most cases of secundum atrial septal defect (ASD). However, reported experience in the pediatric population is limited. To assess procedural characteristics, early clinical outcome and long-term device-related complications after transcatheter closure of ASD in children. A 1998–2014 retrospective multicenter study was performed in 9 French tertiary institutions. All children in whom a percutaneous ASD closure was attempted during the study period were included. In total, 1326 children (39% males, age: 9 years (0.7–18.0), weight: 29 kg [3.6–92]) were included. Median ASD size was 15 mm (3–41). Large ASDs ≥ 20 mm/m 2 were present in 254 (19%) patients. The procedure was performed under fluoroscopic guidance in all cases, assisted with TEE imaging in 856 cases (65%) and TTE in 470 cases (35%). Procedural success rate was 95.3%. Periprocedural complications occurred in 30 (2.2%) patients (including 15 device embolization but no death). After a median follow-up of 4 years (6 months–18 years), no death was observed. The rate of delayed complications 1.04% (95% confidence interval [0.5%–1.6%] including cardiac arrhythmias (n = 8), pulmonary hypertension ( n = 2) and transient ischemic attack (n = 2). No cardiac erosion nor endocarditis were reported. Periprocedural and delayed complications rates were significantly higher in children < 15 kg (6.2% vs 1.9%, P = 0.007; 3.1% vs 0.6%, P < 0.007, respectively) and those with large ASD (3.9% vs 1.8%, P = 0.008 and 1.9% vs 0.4%, P = 0.052, respectively). Our large-scale pediatric cohort confirms that transcatheter closure of isolated secundum ASDs is a safe procedure in children, with a favorable long-term outcome and no life-threatening delayed complication. Children ≤ 15 kg and those with large ASDs had an increased risk of both periprocedural and delayed complications.