Compassionate use of the amplatzer ASD closure device for residual postinfarction ventricular septal rupture following surgical repair

Lowe, Harry C.; Jang, Ik–Kyung; Yoerger, Danita M.; MacGillivray, Thomas E.; Moor, Michael de; Palacios, Igor F.

doi:10.1002/ccd.10525

Cited by 6 publications

(6 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is not uncommon to require additional device implantation either at the time of initial closure or within 3 to 6 days of the initial procedure, and patients and families should be counseled regarding this potential. The risk of subacute recurrence Need for additional devices placement, n (%) 8 (20) Stroke, n (%) 0 (0)…”

Section: Post-ami Vsr: Technical and Procedural Considerationsmentioning

confidence: 99%

See 1 more Smart Citation

Transcatheter Closure of Post-myocardial Infarction Ventricular Septal Rupture

Assenza

McElhinney

Valente

et al. 2013

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

Background-Ventricular septal rupture (VSR) after acute myocardial infarction (AMI) is a potentially lethal mechanical complication of acute coronary syndromes. Given high surgical mortality, transcatheter closure has emerged as a potential strategy in selected cases. We report our single-center experience with double-umbrella device percutaneous closure of post-AMI VSR. Methods and Results-In this single-center, retrospective, cohort study, patients who underwent transcatheter closure of post- AMI VSR between 1988 and2008 at Boston Children's Hospital were included. Data were analysed according to whether the patients underwent direct percutaneous VSR closure or closure of a residual VSR after a previous surgical approach. Primary outcome was mortality rate at 30 days. Clinical predictors of primary outcome were investigated using univariate logistic regression. Thirty patients were included in the study (mean age, 67±8 years). A total of 40 closure devices were implanted. Major periprocedural complications occurred in 4 (13%) patients. Cardiogenic shock, increasing pulmonary/ systemic flow ratio, and the use of the new generation (6-arm) STARFlex device all were associated with higher risk of mortality. The Model for End-Stage Liver Disease Excluding international normalized ratio (MELD-XI) score at the time of VSR closure seemed to be most strongly associated with death (odds ratio, 1.6; confidence interval, 1.1-2.2; P<0.001). Conclusions-Transcatheter closure of post-AMI VSR using CardioSEAL or STARFlex devices is feasible and effective.The MELD-XI score, a marker of multiorgan dysfunction, is a promising risk stratifier in this population of patients. as definitive single therapy, as a bridge to surgery, or for closure of residual defects after surgical repair in selected cases. [8][9][10] To date, the majority of studies of transcatheter closure of post-AMI VSR have reported on the use of Amplatzer atrial septal defect and ventricular septal defect occluders (AGA Medical Corporation, Plymouth, MN). 8-10Recent studies have investigated the utility of the Model for End-Stage Liver Disease (MELD) score as a potential predictor of poor outcomes in patients with heart disease.11,12 A logarithmic function of creatinine, total bilirubin, and international normalized ratio, the MELD score in many ways serves as a simpler marker of multiple organ dysfunction. The modified MELD score Excluding international normalized ratio (MELD-XI score) was validated against the original MELD score and has been shown to be equally able to predict mortality in patients with liver cirrhosis waiting for liver transplantation. 13In this study, we report the outcomes of transcatheter closure of post-AMI VSR using different double-umbrella devices in a consecutive cohort of patients referred during the course of 2 decades to our institution. Methods PopulationIn this single-center, retrospective, cohort study, patients referred to our institution for transcatheter closure of post-AMI VSR between 1988 and 2008 were included. Patients w...

show abstract

Section: Post-ami Vsr: Technical and Procedural Considerationsmentioning

confidence: 99%

“…The majority of the reports on transcatheter closure of post-MI VSR have been limited to a single case or small series of patients. [18][19][20][21][22][23] Larger series reporting on the use of Amplatzer occluder devices present a 30-day mortality rate between 28% and 42%. [8][9][10] In those studies, the intraprocedural death rate ranged from 0% to 17%.…”

mentioning

confidence: 99%

Transcatheter Closure of Post-myocardial Infarction Ventricular Septal Rupture

Assenza

McElhinney

Valente

et al. 2013

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

show abstract

“…Risk factors for VSD include hypertension, advanced age, female gender, diabetes mellitus, the absence of a history of angina or myocardial infarction (MI), and severe coronary stenosis or total occlusion without compensatory collateral circulation [2][3][4] . Despite advances in thrombolysis and percutaneous coronary intervention (PCI) therapy and a perceived decline in the incidence of post-infarction VSD, this still occurs in 0.2% of all patients with AMI [5][6][7] . To date, postinfarction VSD still carries a poor prognosis 8,9 .…”

Section: Introductionmentioning

confidence: 99%

“…To date, postinfarction VSD still carries a poor prognosis 8,9 . Over 80% of untreated patients die within the first month, and >90% within the first year after VSD following AMI 6,10,11 . The mortality of patients with cardiogenic shock due to VSD is as high as 67% within 48 hours and 100% within 30 days 12 .…”

Section: Introductionmentioning

confidence: 99%