Catheter closure of atrial septal defect in the elderly (≥ 65 years). A worthwhile procedure

Thilén, Maria; Christersson, Christina; Dellborg, Mikael; Mattsson, Eva; Trzebiatowska-Krzynska, Aleksandra; Thilén, Ulf

doi:10.1016/j.ijcard.2016.05.024

Cited by 19 publications

(15 citation statements)

References 16 publications

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“…No hemodynamic and thromboembolic complications were observed during the follow-up period (mean 10.6 months). In the SWEDCON registry (Swedish National Registry on Congenital Heart Disease) from 1997 to 2014, the clinical and echocardiographic outcomes of percutaneous ASDC in148 patients ≥ 65 years of age (71.6% female) were reported 25 . At the one-year follow-up, the NYHA witnessed signi cant improvement in functional class (NYHA I from 34-61%, p < 0.001), and this improvement persisted to the latest follow-up more than 4 years after the intervention.…”

Section: Discussionmentioning

confidence: 99%

Short‑to‑mid‑term follow‑up results of transcatheter closure of atrial septal defect in patients older than 60 years

Nguyen

Hoang

2022

Preprint

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Background: Chronological benefits of percutaneous atrial septal defect (ASD) closure in elderly patients (≥60 years) are unclear with remaining residual pulmonary arterial hypertension (PAH) in some patients. This study aims to assess short‑to‑mid‑term clinical and echocardiographic outcomes and identify factors associated with pulmonary arterial hypertension (PAH) in these patients.Methods: Retrospective single-center study of 51 consecutive patients [mean age 63,3 ± 3,2 years, 76% females] undergoing percutaneous ASD closure. Functional status, right ventricular (RV) remodeling and pulmonary artery systolic pressure (PASP) was assessed before and 24 hours after the procedure, at 6 months and 12 months. Logistic regression and Receiver operating characteristic curve analysis were performed to identify factors associated with PAH.Results: The mean ASD size was 21.8 ± 4.4 mm. Compared to before procedure, at 24 hours a significant improvement of NYHA class [NYHA II-III 7 (13.7%) vs. 34 (66.7%) patients, p < 0.0001, respectively], RV size [26.9 ± 5.7 vs. 31,3 ± 5,7 mm, p < 0.0001, respectively] and PASP [26.9 ± 5.7 vs. 50,4 ± 14,2 mm Hg, p<0.001] was detected. At 1 year, RV size and PASP decreased to 22 ± 4.6 mm, p<0.0001 and 33.8 ± 10.8 mmHg, p<0.0001 respectively compared to before ASD closure, residual shunt remained in 9 (17.7%) patients. No deaths were recorded. Age, pre-intervention RV size, pre-intervention PASP and severe tricuspid regurgitation were associated with residual PAH at 1 year in univariate analysis. Pre-intervention PASP ≥ 57.5 mmHg was an independent predictor of residual PAH at 1 year (odds ratio 1.31, 95% confidence interval [CI] 1.04-1.67, p=0.024; c-statistic 0.939, 95% CI 0.865-1.0, p<0.001, sensitivity 80%, specificity 92.6%). Conclusion: Percutaneous ASD closure can be performed safely in older patients and is associated with regression of RV size and PASP as well as symptomatic improvement in the short- and medium-term. Pre-intervention PASP was an independent predictor associated with residual PAH after one year.

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Section: Discussionmentioning

confidence: 99%

Short‑to‑mid‑term follow‑up results of transcatheter closure of atrial septal defect in patients older than 60 years

Nguyen

Hoang

2022

Preprint

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“…Follow-up studies have been performed on adults with aortic valve, coarctation and Mustard/Senning correction, and research has been performed on physical activity and muscle function in adults with congenital heart disease, as well as closure of atrial septal defect by device in the elderly and studies on incidence of endocarditis [13][14][15][16][17]. The SWEDCON registry has been the basis for studies on the transition process from pediatric cardiology to GUCH and the assessment of QoL in children with heart disease, as well as the risk of pulmonary hypertension in children and young adults who were born prematurely [3,18].…”

Section: Discussionmentioning

confidence: 99%

“…Further research using SWEDCON, and by linkage to governmental and other disease specific quality registers, may evaluate preoperative risk factors for predicting intra-and postoperative adverse event and outcomes. Examples are studies of atrial septal defect (ASD) closure in small children as well as in elderly [17,19]. Thus, the valid data retrieved from SWEDCON is well suitable to be used in research studies.…”

Section: Discussionmentioning

confidence: 99%

National quality register of congenital heart diseases – Can we trust the data?

Bodell

Björkhem

Thilén

et al. 2017

J Congenit Heart Dis

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Background: The SWEDish registry of CONgenital heart disease is a Swedish national quality register for collecting data on pediatric and adult (GUCH) patients with congenital heart diseases that aims to improve medical practice and research. The aim of this study was to validate data in the register using data in medical records. Methods: This cross-sectional observational study compared specific variables from SWEDCON with data retrieved from medical records for 182 pediatric and 186 adult patients who were randomly selected from four different hospitals. Results: The absolute concordance for date of visit, diagnosis, information on surgery and catheter intervention was 71-98% between SWEDCON and medical journals. The specificity for cardiac examinations and specific medical therapy was 71-100%. The concordance for information for transition from pediatric care to GUCH or finishing regular check-ups was 92%. Conclusion:The overall concordance between data in SWEDCON-pediatric as well as SWEDCON-GUCH with data in medical records was good, and data from SWEDCON is reliable to use for medical improvements and for research purposes.

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“…This necessitates careful preoperative evaluation of the associated risk factors as an essential aspect of successful treatment. Approximately one third of the patients showed systemic hypertension and systemic diseases like diabetes mellitus, and a considerable extent of pulmonary and neurological disease conditions were also present [109] . Among the cardiac co-morbidities pulmonary hypertension is reported in nearly 50 % of the cases, chronic atrial arrhythmia in more than 20% and ischemic heart disease in about 15% of the patients [110,111] .…”

Section: Obstacles In Transcatheter Atrial Septal Defect Closure In Ementioning

confidence: 99%

Atrial septal defect repair in the age of transcatheter devices

Zimmermann¹,

Hussain²,

Worku³

et al. 2019

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The aim of this review is to discuss the management of atrial septal defects (ASD) in the adult patient paying special attention to the elderly population and the most recent transcatheter advancements. ASDs are characterized by the following categories: ostium secundum, ostium primum, sinus venosus, and coronary sinus defects; though multiple defects may exist concurrently. Intervention for closure of ASDs are indicated with the development of right ventricular volume overload, or in the clinical context of paradoxical embolic stroke. Previously, there was significant disagreement regarding the timing of ASD closure in adult patients, but there is now general consensus that adult patients with clinical evidence of right ventricular overload should undergo closure of ASDs at the time of presentation. The present review describes the typical presentation of patients with symptomatic ASD's, medical management, and whether surgical or percutaneous approach should be pursued. We will also discuss other important considerations for patient selection and potential early and late complications of transcatheter ASD closure such as congestive heart failure, device embolization, and tissue erosion. At the time of this writing, there are currently three FDA-approved devices for percutaneous VSD closure including the Amplatzer TM Septal Occluder (ASO, St. Jude Medical, St. Paul, MN), Gore HELEX TM Septal Occluder (W.L. Gore and Associates, Newark, NJ), and Gore CARDIOFORM TM Septal occluder (GCSO, W.L. Gore and Associates, Newark, NJ) devices. Many premarket approvals were granted for devices that never went to market due to poor investigational study performance. Likewise, the HELEX device has since been discontinued upon bringing the GCSO device to market. We will focus primarily on the ASO device with a brief review of current investigations into the GCSO device, both of which carry an indication for closure small to medium sized ASDs in the ostium secundum position. Additionally, this review covers the safety of transcatheter closure of ASDs with currently available devices, review studies associated with devices available outside the United States, and perioperative considerations for transcatheter Page 2 of 18 Zimmermann et al. Vessel Plus 2019;3:31 I http://dx.intervention. Obstacles to device employment and countermeasures to overcome operational challenges will also be discussed. To this end, variations or similarities of currently approved devices will be emphasized throughout this discussion where possible. Lastly, we will offer insights into device evolution trends with the expectation of new device developments on the horizon. We will briefly discuss up and coming areas of active research, including the emerging fields of novel biomaterials and gene therapy. MORPHOLOGY AND CLINICAL FEATURES OF ASDS Location, Morphology, and suitability for surgery vs. transcatheter interventionIt is important to note that morphological variations of different types of ASDs, which determines whether a particular defect is amenabl...

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Catheter closure of atrial septal defect in the elderly (≥ 65 years). A worthwhile procedure

Cited by 19 publications

References 16 publications

Short‑to‑mid‑term follow‑up results of transcatheter closure of atrial septal defect in patients older than 60 years

Short‑to‑mid‑term follow‑up results of transcatheter closure of atrial septal defect in patients older than 60 years

National quality register of congenital heart diseases – Can we trust the data?

Atrial septal defect repair in the age of transcatheter devices

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