Left atrial appendage and atrial septal occlusion in elderly patients with atrial septal defect and atrial fibrillation

Abstract

Background: Elderly patients with atrial septal defect (ASD) often present with chronic atrial fibrillation and large left to right shunt. This study reports the experience of left atrial appendage (LAA) and ASD closure in patients with significant ASD and chronic atrial fibrillation. Methods: We report six consecutive elderly patients with chronic atrial fibrillation and significant ASD who underwent LAA and fenestrated ASD closure from January 1, 2014 until December 31, 2019. All periprocedural and long-term (>1 year) outcomes were reported. Results: Six patients (male: 33.3%; mean age: 66.8 ± 3.3 years) were included. Mean CHADS 2 , CHA 2 DS 2-VAS c , and HAS-BLED scores were 2.33 ± 0.82, 3.83 ± 0.75, and 1.83 ± 0.75. Four patients underwent simultaneous procedure, while two patients underwent a staged procedure. Procedural success was achieved in all patients. Total occlusion was achieved during LAA occlusion without device embolization prior to ASD closure. Patients who underwent simultaneous procedure had a shorter total hospital stay and lower total hospital stay. During a follow-up period of 32.8 ± 19.4 months, both the devices were well seated. No device-related thrombosis or erosion reported. All patients remained in atrial fibrillation. No patients experienced any thromboembolic stroke or transient ischemic attack. Conclusions: LAA and ASD closure is feasible and can be safely performed in the same seating in elderly patients with a significant ASD.

Efficacy and Safety of Minimally Invasive Transcatheter Closure of Congenital Heart Disease under the Guidance of Transesophageal Ultrasound: A Randomized Controlled Trial

“…Relatively speaking, percutaneous closure is rarely adopted because of the difficulty of vascular dilatation; the guide wire and sheath cannot be vertical defect plane, resulting in the increase of parachute replacement rate, closure difficulty, and the probability of failure; (5) for the ASD with defect diameter > 35 mm and good defect edge condition, the transthoracic approach with short operation path and good occluder release angle is generally chosen. Even so, the difficulty of occlusion and the possibility of failure of occlusion are significantly higher than those of ASD patients with defect diameter ≤ 35 mm, and it is very likely that the occluder is attached or clamped unfirmly because the defect diameter is too large, resulting in the loss of the occluder after operation [ 35 ]. Our research results are consistent with the above conclusions, which shows that this study has good value.…”